Healthcare Provider Details

I. General information

NPI: 1851647499
Provider Name (Legal Business Name): DOUBLE NINE SENIORS CLUB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4719 PALM AVE
HIALEAH FL
33012-4037
US

IV. Provider business mailing address

4719 PALM AVE
HIALEAH FL
33012
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-4459
  • Fax: 305-825-4454
Mailing address:
  • Phone: 305-825-4459
  • Fax: 305-825-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number9210
License Number StateFL

VIII. Authorized Official

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