Healthcare Provider Details

I. General information

NPI: 1780001255
Provider Name (Legal Business Name): SUNSET SENIOR SOCIAL CLUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2014
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9644 SW 72ND ST
MIAMI FL
33173-3250
US

IV. Provider business mailing address

9644 SW 72ND ST
MIAMI FL
33173-3250
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-5250
  • Fax: 305-595-5251
Mailing address:
  • Phone: 305-595-5250
  • Fax: 305-595-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9237
License Number StateFL

VIII. Authorized Official

Name: MRS. NAYS MANDILEGO
Title or Position: OWNER
Credential:
Phone: 305-595-5250