Provider Demographics
NPI:1003960204
Name:JUBILEE MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:JUBILEE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAID
Authorized Official - Middle Name:OLUSEGUN
Authorized Official - Last Name:FASHINA-JINADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-916-0185
Mailing Address - Street 1:580 E 200TH ST
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2391
Mailing Address - Country:US
Mailing Address - Phone:216-916-0185
Mailing Address - Fax:216-916-0185
Practice Address - Street 1:580 E 200TH ST
Practice Address - Street 2:SUITE # 201
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-2391
Practice Address - Country:US
Practice Address - Phone:216-916-0185
Practice Address - Fax:216-916-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2700054Medicaid