Provider Demographics
NPI:1003367111
Name:JUBILEE HEALTHCARE LLC
Entity type:Organization
Organization Name:JUBILEE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:2016-10-24
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH502330Medicare PIN