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General NPI Number Information
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NPI Number | 1992670525
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Entity Type | Organization
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Legal Business Name | WGH OPCO
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 37 CENTRAL AVE
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City | WELLSBORO
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State | PA
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Zip | 16901-1857
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Country | US
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Telephone | 570-723-7764
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Fax |
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Provider Business Mailing Address
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Address Line | 377 PEARSALL AVE STE A
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City | CEDARHURST
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State | NY
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Zip | 11516-1841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | GEDALIAH WIELGUS
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Credential |
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Telephone | 517-258-8708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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