Healthcare Provider Details

I. General information

NPI: 1093206138
Provider Name (Legal Business Name): JUBILEE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13170 RAVENNA RD STE 200
CHARDON OH
44024-7022
US

IV. Provider business mailing address

24651 CENTER RIDGE RD STE 350
WESTLAKE OH
44145-5627
US

V. Phone/Fax

Practice location:
  • Phone: 844-542-6363
  • Fax: 216-455-1810
Mailing address:
  • Phone: 440-895-5056
  • Fax: 440-895-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KELLY A MOWRER
Title or Position: CREDENTIALING
Credential:
Phone: 440-895-5056