Organization
HYDRATION SPARK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JABULANI SIDILE MD (MEDICAL DIRECTOR)
(513) 633-0088
Entity
Organization
Contact information
Practice address
1118 EUCLID AVE STE B, CLEVELAND, OH 44115-1627
(216) 293-5252
Mailing address
1118 EUCLID AVE STE B, CLEVELAND, OH 44115-1627
(216) 293-5252
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
261QX0200X
Oncology Clinic/Center
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Enumeration date
06/21/2022
Last updated
03/09/2023
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