MEDICARE: JUBILEE ADULT DAY CENTER INC

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	261QA0600X	Adult Day Care Clinic/Center		IL
2	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1396703021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUBILEE ADULT DAY CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 967
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-0967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1738 W 99TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-2116
Country	:	US
Telephone Number	:	773-233-2408
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	WAYNE BLAKE
Credential	:	DO
Telephone Number	:	773-233-2408

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	09/11/2025

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