1417089350 NPI number — DIGNITY COMMUNITY CARE

Table of content: (NPI 1417089350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417089350 NPI number — DIGNITY COMMUNITY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGNITY COMMUNITY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHRIDGE HOSPITAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417089350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3215 PROSPECT PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-6017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-488-7667
Provider Business Mailing Address Fax Number:
916-414-4741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18300 ROSCOE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-885-8500
Provider Business Practice Location Address Fax Number:
818-885-5439
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
818-885-5321

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  930000114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 930000114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 930000114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NHRC . This is a "UNIVERSAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2720268 . This is a "AETNA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 870692258 . This is a "IRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30116F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40116G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZA1957Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050116B0000 . This is a "CMS SECTION 1011" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP00685 . This is a "DHS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSM30116G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30116G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870692258913250000 . This is a "WPS TRICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CGP010485 . This is a "DHS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HSC30116G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HSM30116F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30116F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40116F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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