Provider Demographics
NPI:1124696349
Name:GOLD STAR COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:GOLD STAR COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDZHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-877-2788
Mailing Address - Street 1:6343 VINELAND AVE
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3721
Mailing Address - Country:US
Mailing Address - Phone:747-877-2789
Mailing Address - Fax:
Practice Address - Street 1:6343 VINELAND AVE
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3721
Practice Address - Country:US
Practice Address - Phone:747-877-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)