Provider Demographics
NPI:1518410547
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 1:36711 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4062
Mailing Address - Country:US
Mailing Address - Phone:440-653-6091
Mailing Address - Fax:440-653-8089
Practice Address - Street 1:36711 AMERICAN WAY
Practice Address - Street 2:SUITE A
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4062
Practice Address - Country:US
Practice Address - Phone:440-653-6091
Practice Address - Fax:440-653-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty