MEDICARE: JUBILEE HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1003367111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUBILEE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	36711 AMERICAN WAY
Second Line	:	SUITE A
City	:	AVON
State	:	OH
Zip	:	44011-4062
Country	:	US
Telephone Number	:	440-653-6091
Fax Number	:	440-653-8089

Provider Business Practice Location Address
First Line	:	36711 AMERICAN WAY
Second Line	:	SUITE A
City	:	AVON
State	:	OH
Zip	:	44011-4062
Country	:	US
Telephone Number	:	440-653-6091
Fax Number	:	440-653-8089

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FRED DEGRANDIS
Credential	:
Telephone Number	:	216-312-5059

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	01/31/2017

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Directions to “JUBILEE HEALTHCARE LLC ” Practice Location

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