MEDICARE: HOUR OF CHANGE FITNESS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	163W00000X	Registered Nurse
2	225700000X	Massage Therapist
3	390200000X	Student in an Organized Health Care Education/Training Program
4	376K00000X	Nurse's Aide
5	174H00000X	Health Educator
6	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1861798480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUR OF CHANGE FITNESS, INC

Provider Business Mailing Address
First Line	:	2603 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6924
Country	:	US
Telephone Number	:	773-552-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6924
Country	:	US
Telephone Number	:	773-552-5077
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. NNAMDI I UGBAJA
Credential	:	B..S.
Telephone Number	:	773-552-5077

Provider Enumeration Date	:	01/29/2011
Last Update Date	:	06/25/2014

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Directions to “HOUR OF CHANGE FITNESS, INC ” Practice Location

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