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General NPI Number Information
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NPI Number | 1720841687
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Entity Type | Organization
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Legal Business Name | BODII CAFE INCORPORATED
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 3317-19 W. 95TH ST SUITE 4
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2243
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Country | US
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Telephone | 312-600-5592
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Fax |
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Provider Business Mailing Address
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Address Line | 9449 S KEDZIE AVE STE 342
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2325
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Country | US
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Telephone | 312-600-5592
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Fax |
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Authorized Official
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Title or Position | OWNER: ONCOLOGY SKINCARE CONSULTANT
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Name | MS. STEPHANIE MARIE FREE
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Credential | HEALTH EDUCATOR
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Telephone | 312-600-5592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224900000X
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Taxonomy Name | Mastectomy Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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