Healthcare Provider Details

I. General information

NPI: 1942079975
Provider Name (Legal Business Name): ENBODYLIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16808 CHAGRIN BLVD
SHAKER HEIGHTS OH
44120-3724
US

IV. Provider business mailing address

1408 S GREEN RD
SOUTH EUCLID OH
44121-3920
US

V. Phone/Fax

Practice location:
  • Phone: 440-409-2023
  • Fax: 216-415-6858
Mailing address:
  • Phone: 440-409-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFINNE PERKINS
Title or Position: CEO
Credential:
Phone: 216-415-6818