MEDICARE: JUBILEE HEALTH 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	323P00000X	Psychiatric Residential Treatment Facility	036109969	IL

General Provider Information

NPI Number	:	1932330446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUBILEE HEALTH INC

Provider Business Mailing Address
First Line	:	1016 VICTORIA LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 VICTORIA LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4508
Country	:	US
Telephone Number	:	630-379-8183
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	MR. ABDI TINWALLA
Credential	:
Telephone Number	:	630-379-8183

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	07/31/2009

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