1467560599 NPI number — DIGNITY COMMUNITY CARE

Table of content: (NPI 1467560599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467560599 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:
Provider Other Organization Name Type Code:
6
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:
1467560599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2019
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:
916-861-1102
Provider Business Mailing Address Fax Number:
916-861-7707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-423-3000
Provider Business Practice Location Address Fax Number:
916-423-6045
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOCIE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
916-423-6100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  030000064 , 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: 030000064 , 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: HSP40590G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721561131 . This is a "IRS - SP TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 721561131958230000 . This is a "WPS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203949200 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC00590G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CGP021560 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZR00590G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC55344G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 941580397 . This is a "PRIOR SP TAX" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3406Z . This is a "BLUE SHIELD OF CA" identifier . This identifiers is of the category "OTHER".




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