Healthcare Provider Details

I. General information

NPI: 1275373490
Provider Name (Legal Business Name): EMMA'S HYDRATION THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BOULEVARD SOUTH SW STE 104
HUNTSVILLE AL
35802-2175
US

IV. Provider business mailing address

600 BOULEVARD SOUTH SW STE 104
HUNTSVILLE AL
35802-2175
US

V. Phone/Fax

Practice location:
  • Phone: 256-417-2607
  • Fax:
Mailing address:
  • Phone: 256-417-2607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ROBERTS
Title or Position: CEO/FOUNDER
Credential: RN BSN
Phone: 256-417-2607