Provider Demographics
NPI:1093074437
Name:GOLDEN JUBILEE HEALTHCARE INC.
Entity Type:Organization
Organization Name:GOLDEN JUBILEE HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCELOT
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-607-9998
Mailing Address - Street 1:4016 BLOOMINGTON AVE. SOUTH
Mailing Address - Street 2:MINNEAPOLIS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-607-9998
Mailing Address - Fax:
Practice Address - Street 1:4016 BLOOMINGTON AVE
Practice Address - Street 2:MINNEAPOLIS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3331
Practice Address - Country:US
Practice Address - Phone:612-607-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care