Provider Demographics
NPI:1629508619
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:
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 STE A
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4062
Mailing Address - Country:US
Mailing Address - Phone:440-808-1222
Mailing Address - Fax:
Practice Address - Street 1:5105 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4203
Practice Address - Country:US
Practice Address - Phone:216-285-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
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