MEDICARE: SUNSET SENIOR SOCIAL CLUB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	9237	FL

General Provider Information

NPI Number	:	1780001255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSET SENIOR SOCIAL CLUB

Provider Business Mailing Address
First Line	:	9644 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3250
Country	:	US
Telephone Number	:	305-595-5250
Fax Number	:	305-595-5251

Provider Business Practice Location Address
First Line	:	9644 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3250
Country	:	US
Telephone Number	:	305-595-5250
Fax Number	:	305-595-5251

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NAYS MANDILEGO
Credential	:
Telephone Number	:	305-595-5250

Provider Enumeration Date	:	03/23/2014
Last Update Date	:	10/15/2015

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Directions to “SUNSET SENIOR SOCIAL CLUB ” Practice Location

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