Provider Demographics
NPI:1154644615
Name:JUBILEE PERSONAL CARE HOME INC.
Entity Type:Organization
Organization Name:JUBILEE PERSONAL CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:NWADIUTO
Authorized Official - Last Name:OKEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-538-8221
Mailing Address - Street 1:3221 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-3636
Mailing Address - Country:US
Mailing Address - Phone:770-943-4214
Mailing Address - Fax:770-943-4063
Practice Address - Street 1:3221 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-3636
Practice Address - Country:US
Practice Address - Phone:770-943-4214
Practice Address - Fax:770-943-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-01-160-1320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities