Provider Demographics
NPI:1407641665
Name:DIGNITY COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:DIGNITY COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:LAQEISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGANS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:909-312-9480
Mailing Address - Street 1:12352 RUTHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8871
Mailing Address - Country:US
Mailing Address - Phone:909-312-9480
Mailing Address - Fax:
Practice Address - Street 1:13631 JEREMY CT
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2031
Practice Address - Country:US
Practice Address - Phone:909-803-0601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children