Provider Demographics
NPI:1306397120
Name:JUBILEE HEALTHCARE LLC
Entity Type:Organization
Organization Name:JUBILEE HEALTHCARE LLC
Other - Org Name:NORTH SHORE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-312-5059
Mailing Address - Street 1:25200 CENTER RIDGE RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4146
Mailing Address - Country:US
Mailing Address - Phone:844-746-8537
Mailing Address - Fax:216-450-1810
Practice Address - Street 1:25200 CENTER RIDGE RD STE 1100
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:844-746-8537
Practice Address - Fax:216-450-1810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0192836Medicaid