| 515 Fitness Inc. | |
|
624 W Roosevelt Rd Wheaton IL 60187-5060 | |
| (708) 232-0258 | |
| Not Available |
| Full Name | 515 Fitness Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 624 W Roosevelt Rd, Wheaton, Illinois |
| Authorized Official Name and Position | Nicole Perry (CEO AND FOUNDER) |
| Authorized Official Contact | 4406676195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 515 Fitness Inc. 713 Warrenville Rd Wheaton IL 60189-6368 Ph: (440) 667-6195 | 515 Fitness Inc. 624 W Roosevelt Rd Wheaton IL 60187-5060 Ph: (708) 232-0258 |
| NPI Number | 1134508310 |
|---|---|
| Provider Enumeration Date | 05/21/2015 |
| Last Update Date | 09/19/2024 |
| Certification Date | 09/19/2024 |
| Medicare PECOS PAC ID | 6103172341 |
|---|---|
| Medicare Enrollment ID | O20180702001423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134508310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180.007735 (Illinois) | Primary |
| Provider Name | Nicole Perry |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083006563 PECOS PAC ID: 2163778309 Enrollment ID: I20240109000279 |
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