Healthcare Provider Details

I. General information

NPI: 1427433002
Provider Name (Legal Business Name): DOUBLE NINE SENIORS CLUB II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 W 4TH AVE
HIALEAH FL
33012-3907
US

IV. Provider business mailing address

4670 W 4TH AVE
HIALEAH FL
33012-3907
US

V. Phone/Fax

Practice location:
  • Phone: 305-775-7439
  • Fax: 305-825-4454
Mailing address:
  • Phone: 305-775-7439
  • Fax: 305-825-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9324
License Number StateFL

VIII. Authorized Official

Name: MRS. YOLANDA LUGONES
Title or Position: OWNER
Credential:
Phone: 305-775-7439