Provider Demographics
NPI:1184148900
Name:JUBILEE HEALTHCARE, LLC
Entity type:Organization
Organization Name:JUBILEE HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:TONN-KNOPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-315-8896
Mailing Address - Street 1:32730 WALKER RD STE J
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-4100
Mailing Address - Country:US
Mailing Address - Phone:440-455-3080
Mailing Address - Fax:440-653-9670
Practice Address - Street 1:32730 WALKER RD STE J
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-4100
Practice Address - Country:US
Practice Address - Phone:440-455-3080
Practice Address - Fax:440-653-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0192836Medicaid