MEDICARE: JUBILEE DOULA, 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	374J00000X	Doula

General Provider Information

NPI Number	:	1871967844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUBILEE DOULA, LLC

Provider Business Mailing Address
First Line	:	3252 NIAGARA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-2212
Country	:	US
Telephone Number	:	719-439-5394
Fax Number	:

Provider Business Practice Location Address
First Line	:	3252 NIAGARA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-2212
Country	:	US
Telephone Number	:	719-439-5394
Fax Number	:

Authorized Official
Title or Position	:	FOUNDING BIRTH DOULA
Name	:	ELIZABETH CHARLOTTE GRANT
Credential	:
Telephone Number	:	719-439-5394

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/13/2015

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