1962739920 NPI number — ONE HOUR WELLNESS CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962739920 NPI number — ONE HOUR WELLNESS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE HOUR WELLNESS CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962739920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1324 N MILWAUKEE AVE
Provider Second Line Business Mailing Address:
STE. 350
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622-9148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-208-4968
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1324 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
STE. 350
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-9148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-208-4968
Provider Business Practice Location Address Fax Number:
847-897-5990
Provider Enumeration Date:
11/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZUHIRA
Authorized Official First Name:
WILL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-208-4968

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038010923 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 038010923 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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