NPIMap

Organization Active NPI

Jubilee Healthcare, LLC

  • Durable Medical Equipment & Medical Supplies
  • Willoughby, OH
National Provider Identifier
1629508619
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
JUBILEE HEALTHCARE, LLC
Doing business as
North Shore Healthcare
NorthShore Healthcare
Practice address
5105 Som Center Rd
Willoughby, OH 44094-4203
Phone
(216) 285-5115
NPI assigned
Jun 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Fred Degrandis
Title
President
Phone
(216) 312-5059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

5105 Som Center Rd
Willoughby, OH 44094-4203

Mailing address

36711 American Way Ste a
Avon, OH 44011-4062
Phone (440) 808-1222

Other identifiers 1

IdentifierTypeStateIssuer
0192836MedicaidOH

Other names 2

  • North Shore Healthcare Doing business as
  • NorthShore Healthcare Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Jubilee Healthcare LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1629508619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36711 AMERICAN WAY STE A",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440114062",
            "telephone_number": "440-808-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5105 SOM CENTER RD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944203",
            "telephone_number": "216-285-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUBILEE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-13",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "DEGRANDIS",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "216-312-5059"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0192836",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NorthShore Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.