Provider Demographics
NPI:1972541498
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:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORISSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-275-8112
Mailing Address - Street 1:3215 PROSPECT PARK DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6017
Mailing Address - Country:US
Mailing Address - Phone:858-275-8112
Mailing Address - Fax:779-803-8118
Practice Address - Street 1:6501 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0306
Practice Address - Country:US
Practice Address - Phone:858-275-8112
Practice Address - Fax:779-803-8118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
CA030000063282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
942761692956080014OtherWPS TRICARE
CA196456501OtherDEPT. OF LABOR - WC
CACGP021540Medicaid
CAZZR00516FMedicaid
942761692OtherIRS - PRE-MERGER TAX ID
ZZZA3403ZOtherBLUE SHIELD OF CA
CAHSC00516FMedicaid
CAHSC40516GOtherCMISP - TRAUMA
CAHSP40516FMedicaid
CAHSP40516FMedicaid