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General NPI Number Information
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NPI Number | 1629709605
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Entity Type | Organization
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Legal Business Name | HYDRATION SPARK LLC
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 1118 EUCLID AVE STE B
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City | CLEVELAND
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State | OH
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Zip | 44115-1627
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Country | US
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Telephone | 216-293-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 EUCLID AVE STE B
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City | CLEVELAND
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State | OH
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Zip | 44115-1627
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Country | US
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Telephone | 216-293-5252
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JABULANI SIDILE
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Credential | MD
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Telephone | 513-633-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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