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General NPI Number Information
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NPI Number | 1942079975
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Entity Type | Organization
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Legal Business Name | ENBODYLIFE
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 16808 CHAGRIN BLVD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-3724
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Country | US
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Telephone | 440-409-2023
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Fax | 216-415-6858
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Provider Business Mailing Address
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Address Line | 1408 S GREEN RD
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City | SOUTH EUCLID
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State | OH
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Zip | 44121-3920
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Country | US
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Telephone | 440-409-2023
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIFFINNE PERKINS
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Credential |
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Telephone | 216-415-6818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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