Provider Demographics
NPI:1720841687
Name:BODII CAFE
Entity type:Organization
Organization Name:BODII CAFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER: ONCOLOGY SKINCARE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH EDUCATOR
Authorized Official - Phone:312-600-5592
Mailing Address - Street 1:9449 S KEDZIE AVE STE 342
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:312-600-5592
Mailing Address - Fax:
Practice Address - Street 1:3317-19 W. 95TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2243
Practice Address - Country:US
Practice Address - Phone:312-600-5592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty
No251E00000XAgenciesHome Health