# DIGNITY HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DIGNITY HEALTH
- **Other names:** Mercy Medical Center Mt Shasta DP SNF
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1376535344
- **Legal business name:** DIGNITY HEALTH
- **Authorized official:** JOE D'ANGINA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (530) 225-6121

## Contact information

- **Practice address:** 914 PINE ST, MOUNT SHASTA, CA 96067-2143
- **Practice address phone:** (530) 926-6111
- **Practice address fax:** (530) 926-9373
- **Mailing address:** 914 PINE ST, MOUNT SHASTA, CA 96067-2143
- **Mailing address phone:** (530) 926-6111
- **Mailing address fax:** (530) 926-9373

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 230000015 | CA | Yes |

## Other

- **Enumeration date:** 08/16/2005
- **Last updated:** 01/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 721561129 | IRS | CA |
| 01 | — | 721561129960670000 | WPS-TRICARE | CA |
| 05 | — | LTC55282H | — | CA |