Organization
HYDRASPA REJUVENATION STATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE LUCAS RN (CHIEF NURSING OFFICER)
(980) 310-6381
Entity
Organization
Contact information
Practice address
11 UNION ST S STE 105, CONCORD, NC 28025-5088
(980) 310-6381
Mailing address
10301 WINDTREE LN, CHARLOTTE, NC 28215-9019
(980) 310-6381
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
—
—
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
3336H0001X
Home Infusion Therapy Pharmacy
—
—
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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