Provider Demographics
NPI:1689360562
Name:JUBILEE CARE LLC
Entity Type:Organization
Organization Name:JUBILEE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KASS-YIRENKYI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:551-275-6632
Mailing Address - Street 1:1442 BROAD ST STE 208
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3046
Mailing Address - Country:US
Mailing Address - Phone:646-685-9604
Mailing Address - Fax:
Practice Address - Street 1:1442 BROAD ST STE 208
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3046
Practice Address - Country:US
Practice Address - Phone:646-685-9604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No302R00000XManaged Care OrganizationsHealth Maintenance Organization