=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053768515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WGM CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2016
-----------------------------------------------------
Last Update Date | 08/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 W COLTON AVE SUITE 529
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-976-1014
-----------------------------------------------------
Fax | 800-976-1014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1255 W COLTON AVE SUITE 529
-----------------------------------------------------
City | REDLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92374-2861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-976-1014
-----------------------------------------------------
Fax | 800-976-1014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MS. BHAVNA UPPAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-726-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------