Healthcare Provider Details

I. General information

NPI: 1912122110
Provider Name (Legal Business Name): JUBALIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 SHELBYVILLE RD SUITE 203
LOUISVILLE KY
40222-5586
US

IV. Provider business mailing address

PO BOX 221096
LOUISVILLE KY
40252-1096
US

V. Phone/Fax

Practice location:
  • Phone: 502-403-1086
  • Fax: 502-403-1074
Mailing address:
  • Phone: 502-403-1086
  • Fax: 502-403-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORETTA FAYE BAKER
Title or Position: PRESIDENT
Credential: M.DIV
Phone: 502-403-1086