| Stargate Behavioral Health Services LLC | |
|
1924 W Alta Vista Rd Phoenix AZ 85041-5443 | |
| (901) 652-8154 | |
| Not Available |
| Full Name | Stargate Behavioral Health Services LLC |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1924 W Alta Vista Rd, Phoenix, Arizona |
| Authorized Official Name and Position | Sekou a Donzo (CEO) |
| Authorized Official Contact | 2166309350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stargate Behavioral Health Services LLC 1924 W Alta Vista Rd Phoenix AZ 85041-5443 Ph: (901) 652-8154 | Stargate Behavioral Health Services LLC 1924 W Alta Vista Rd Phoenix AZ 85041-5443 Ph: (901) 652-8154 |
| NPI Number | 1063974533 |
|---|---|
| Provider Enumeration Date | 04/03/2019 |
| Last Update Date | 01/28/2020 |
| Certification Date | 01/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063974533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | () | Primary |
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