Provider Demographics
NPI:1174399935
Name:JUBILEE MENTAL HEALTH GROUP, A PROFESSIONAL NURSING ORGANIZATION
Entity type:Organization
Organization Name:JUBILEE MENTAL HEALTH GROUP, A PROFESSIONAL NURSING ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:909-272-2336
Mailing Address - Street 1:16755 VON KARMAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-4963
Mailing Address - Country:US
Mailing Address - Phone:909-272-2336
Mailing Address - Fax:714-202-8858
Practice Address - Street 1:16755 VON KARMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-4963
Practice Address - Country:US
Practice Address - Phone:714-202-8858
Practice Address - Fax:714-202-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty