Healthcare Provider Details

I. General information

NPI: 1861798480
Provider Name (Legal Business Name): HOUR OF CHANGE FITNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2011
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 W NORTH AVE
CHICAGO IL
60647-6924
US

IV. Provider business mailing address

2603 W NORTH AVE
CHICAGO IL
60647-6924
US

V. Phone/Fax

Practice location:
  • Phone: 773-552-5077
  • Fax:
Mailing address:
  • Phone: 773-552-5077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

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