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General NPI Number Information
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NPI Number | 1114269115
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Entity Type | Organization
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Legal Business Name | JUBILEE BEHAVIORAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 03/18/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1512 FLORIDA AVE
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City | LYNCHBURG
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State | VA
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Zip | 24501-4112
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Country | US
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Telephone | 434-845-0433
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Fax | 434-845-4740
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Provider Business Mailing Address
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Address Line | 1512 FLORIDA AVE
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City | LYNCHBURG
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State | VA
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Zip | 24501-4112
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Country | US
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Telephone | 434-845-0433
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. STERLING ALLEN WILDER
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Credential | M.ED
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Telephone | 434-444-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1886
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License Number State | VA
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