Provider Demographics
NPI:1255667358
Name:JUBILEE INTERCONTINENTAL CO. LLC
Entity Type:Organization
Organization Name:JUBILEE INTERCONTINENTAL CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:UWAGBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-983-9985
Mailing Address - Street 1:5828 SOMERTON DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8590
Mailing Address - Country:US
Mailing Address - Phone:817-983-9985
Mailing Address - Fax:817-695-9094
Practice Address - Street 1:5828 SOMERTON DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8590
Practice Address - Country:US
Practice Address - Phone:817-983-9985
Practice Address - Fax:817-695-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health