Provider Demographics
NPI:1194877332
Name:DIGNITY HEALTH
Entity type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-988-2500
Mailing Address - Street 1:2415 ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1459
Mailing Address - Country:US
Mailing Address - Phone:805-389-5800
Mailing Address - Fax:805-383-7460
Practice Address - Street 1:2309 ANTONIO AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1414
Practice Address - Country:US
Practice Address - Phone:805-389-5632
Practice Address - Fax:805-383-7450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000048282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30616IMedicaid
51406OtherAETNA
CAHSC30616IMedicaid
CAHSP40616IMedicaid
ZZZA5606ZOtherBLUE SHIELD
870692236930100000OtherWPS
CALTC70024GMedicaid
870692236OtherIRS
870692236930100002OtherWPS
870692236BOtherHEALTHNET
CALTC55223GMedicaid
ZZZA5606ZOtherBLUE SHIELD
870692236OtherIRS
CAHSP30616IMedicaid