Healthcare Provider Details

I. General information

NPI: 1306397120
Provider Name (Legal Business Name): JUBILEE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25200 CENTER RIDGE RD STE 1100
WESTLAKE OH
44145
US

IV. Provider business mailing address

25200 CENTER RIDGE RD STE 1100
WESTLAKE OH
44145-4146
US

V. Phone/Fax

Practice location:
  • Phone: 844-746-8537
  • Fax: 216-450-1810
Mailing address:
  • Phone: 844-746-8537
  • Fax: 216-450-1810

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: MR. FRED DEGRANDIS
Title or Position: PRESIDENT
Credential:
Phone: 216-312-5059