Provider Demographics
NPI:1609468917
Name:STARGATE HEALTH SOLUTIONS, INC
Entity Type:Organization
Organization Name:STARGATE HEALTH SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:OLANTUNJI
Authorized Official - Last Name:ONIGBOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:267-323-5254
Mailing Address - Street 1:1916 WELSH ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1916 WELSH ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4654
Practice Address - Country:US
Practice Address - Phone:215-677-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty