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:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PASCUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-537-5153
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:916-861-1102
Mailing Address - Fax:916-861-7707
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:916-537-5000
Practice Address - Fax:916-537-5111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2021-06-21
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
CA196456501OtherDEPT. OF LABOR - WC
ZZZA3403ZOtherBLUE SHIELD OF CA
CACGP021540Medicaid
942761692956080014OtherWPS TRICARE
CAHSC40516GOtherCMISP - TRAUMA
942761692OtherIRS - PRE-MERGER TAX ID
CAHSC00516FMedicaid
CAHSP40516FMedicaid
CAZZR00516FMedicaid
CAHSP40516FMedicaid