Healthcare Provider Details

I. General information

NPI: 1053997205
Provider Name (Legal Business Name): JUBILEE HEALTH VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4637 COLONEL FENWICK PL
UPPER MARLBORO MD
20772-5924
US

IV. Provider business mailing address

4637 COLONEL FENWICK PL
UPPER MARLBORO MD
20772-5924
US

V. Phone/Fax

Practice location:
  • Phone: 240-510-3331
  • Fax: 240-339-1947
Mailing address:
  • Phone: 240-299-3987
  • Fax: 240-339-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. OLIVIA ONYECHI
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 240-299-3987