Healthcare Provider Details

I. General information

NPI: 1295551943
Provider Name (Legal Business Name): JUBILANT HEARTS HEALTHCARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W 111TH ST
CHICAGO IL
60655-2251
US

IV. Provider business mailing address

7348 S WOODLAWN AVE
CHICAGO IL
60619-2020
US

V. Phone/Fax

Practice location:
  • Phone: 312-843-0830
  • Fax: 773-409-8763
Mailing address:
  • Phone: 773-668-1686
  • Fax: 773-409-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KATINA EDWARDS
Title or Position: CEO
Credential:
Phone: 312-843-0830