MEDICARE: HYDRATION SPARK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251F00000X	Home Infusion Agency
2	261QP3300X	Pain Clinic/Center
3	261QX0200X	Oncology Clinic/Center
4	3336H0001X	Home Infusion Therapy Pharmacy
5	261QI0500X	Infusion Therapy Clinic/Center

General Provider Information

NPI Number	:	1629709605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYDRATION SPARK LLC

Provider Business Mailing Address
First Line	:	1118 EUCLID AVE STE B
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1627
Country	:	US
Telephone Number	:	216-293-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 EUCLID AVE STE B
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1627
Country	:	US
Telephone Number	:	216-293-5252
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JABULANI SIDILE
Credential	:	MD
Telephone Number	:	513-633-0088

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	03/09/2023

Similar Medicare Providers

1770680357 — DR. JEFFREY D SOLOMON DPM
Practice Location Address:

6131 SAINT CLAIR AVE
CLEVELAND, OH
44103-1627

Practice Phone: 718-387-7628
Practice Fax:

1700090925 — CUYAHOGA COUNTY BD OF MRDD
Practice Location Address:

1374 EDENDALE ST
CLEVELAND HTS, OH
44121-1627

Practice Phone: 216-736-2625
Practice Fax: 216-736-2702

1144661224 — VILLAGE PREPARATORY WOODLAND HILLS
Practice Location Address:

9201 CRANE AVE
CLEVELAND, OH
44105-1627

Practice Phone: 216-456-2086
Practice Fax: 216-391-4770

1073954145 — ENTREPRENEURSHIP PREPARATORY WOODLAND HILLS
Practice Location Address:

9201 CRANE AVE
CLEVELAND, OH
44105-1627

Practice Phone: 216-456-2086
Practice Fax: 216-391-4770

1447650650 — MUM-FORD INC
Practice Location Address:

6129 SAINT CLAIR AVE
CLEVELAND, OH
44103-1627

Practice Phone: 216-541-3937
Practice Fax: 216-391-3930

1275194805 — UNITED CEREBRAL PALSY ASSOCIATION OF GREATER CLEVELAND, INC.
Practice Location Address:

1374 EDENDALE ST
CLEVELAND HEIGHTS, OH
44121-1627

Practice Phone: 216-381-9993
Practice Fax:

Directions to “HYDRATION SPARK LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.