Provider Demographics
NPI:1821724709
Name:STAR GATE CORP
Entity Type:Organization
Organization Name:STAR GATE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GEVOJANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-213-8983
Mailing Address - Street 1:543 COUNTRY CLUB DR # 525
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0637
Mailing Address - Country:US
Mailing Address - Phone:818-213-8983
Mailing Address - Fax:
Practice Address - Street 1:30700 RUSSELL RANCH RD STE 250
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-9507
Practice Address - Country:US
Practice Address - Phone:818-213-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health