=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528304201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWO SISTERS HOME II CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2012
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12335 NW 98TH AVE
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018-2957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-640-5068
-----------------------------------------------------
Fax | 305-822-7266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12335 NW 98 AVE
-----------------------------------------------------
City | HIALEAH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-640-5068
-----------------------------------------------------
Fax | 605-822-7266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ODRISAMER DESPAIGNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 623-999-4860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10285
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------