Healthcare Provider Details

I. General information

NPI: 1720841687
Provider Name (Legal Business Name): BODII CAFE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317-19 W. 95TH ST SUITE 4
EVERGREEN PARK IL
60805-2243
US

IV. Provider business mailing address

9449 S KEDZIE AVE STE 342
EVERGREEN PARK IL
60805-2325
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-5592
  • Fax:
Mailing address:
  • Phone: 312-600-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE MARIE FREE
Title or Position: OWNER: ONCOLOGY SKINCARE CONSULTANT
Credential: HEALTH EDUCATOR
Phone: 312-600-5592