Provider Demographics
NPI:1194938092
Name:DIGNITY HEALTHCARE, LLC
Entity type:Organization
Organization Name:DIGNITY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BRUURSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:816-795-5534
Mailing Address - Street 1:17201 EAST U.S. 40 HWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6438
Mailing Address - Country:US
Mailing Address - Phone:816-795-5534
Mailing Address - Fax:816-795-5526
Practice Address - Street 1:17201 EAST US 40 HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6438
Practice Address - Country:US
Practice Address - Phone:816-795-5534
Practice Address - Fax:816-795-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO722792-0-095-0000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health