=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518964741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E G & T CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2005
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 745 N WHITNALL HWY.
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-566-1930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 745 N WHITNALL HWY.
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-566-1930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ELIA S GRIS
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 818-566-1020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 980001346
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------