Provider Demographics
NPI:1083384127
Name:THE HYDRATION BAR LLC
Entity Type:Organization
Organization Name:THE HYDRATION BAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAKEENA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:205-215-7926
Mailing Address - Street 1:426 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6075
Mailing Address - Country:US
Mailing Address - Phone:205-215-7926
Mailing Address - Fax:
Practice Address - Street 1:1405 THOMPSON CIR # 200
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2749
Practice Address - Country:US
Practice Address - Phone:205-473-0070
Practice Address - Fax:205-273-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center