Healthcare Provider Details

I. General information

NPI: 1225949043
Provider Name (Legal Business Name): JUBILEE TIME HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14023 CRENSHAW BLVD STE 10
HAWTHORNE CA
90250-9255
US

IV. Provider business mailing address

14023 CRENSHAW BLVD STE 10
HAWTHORNE CA
90250-9255
US

V. Phone/Fax

Practice location:
  • Phone: 562-396-1831
  • Fax: 310-758-5730
Mailing address:
  • Phone: 562-396-1831
  • Fax: 310-758-5730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIVIENNE AGHOGHO AYOMANOR
Title or Position: DNP/ DIRECTOR
Credential: PMHNP-BC, FNP-C
Phone: 562-396-1831