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General NPI Number Information
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NPI Number | 1629508619
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Entity Type | Organization
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Legal Business Name | JUBILEE HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 5105 SOM CENTER RD
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4203
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Country | US
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Telephone | 216-285-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 36711 AMERICAN WAY STE A
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City | AVON
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State | OH
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Zip | 44011-4062
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Country | US
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Telephone | 440-808-1222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRED DEGRANDIS
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Credential |
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Telephone | 216-312-5059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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