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1821724709 NPI number — STAR GATE CORP

NPI Number: 1821724709
Health Care Provider/Practitioner: STAR GATE CORP

Information about “1821724709” NPI (STAR GATE CORP) exists in 1821724709 in HTML format HTML  |  1821724709 in plain Text format TXT  |  1821724709 in PDF (Portable Document Format) PDF  |  1821724709 in an XML format XML  formats.

NPI Number : 1821724709 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821724709",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "STAR GATE CORP",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "543 COUNTRY CLUB DR # 525",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SIMI VALLEY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "93065-0637",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "818-213-8983",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "30700 RUSSELL RANCH RD STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WESTLAKE VILLAGE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91362-9507",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "818-213-8983",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/25/2022",
    "LastUpdateDate": "07/25/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GEVOJANYAN",
    "AuthorizedOfficialFirstName": "GEORGE",
    "AuthorizedOfficialMiddleName": "GEORGE",
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "818-213-8983",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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