MEDICARE: DOLORES SENIOR SOCIAL CLUB LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1831055961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLORES SENIOR SOCIAL CLUB LLC

Provider Business Mailing Address
First Line	:	735 NE 19TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-7812
Country	:	US
Telephone Number	:	239-517-2578
Fax Number	:	239-208-4648

Provider Business Practice Location Address
First Line	:	735 NE 19TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-7812
Country	:	US
Telephone Number	:	239-517-2578
Fax Number	:	239-208-4648

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PEDRO JUAN MATO MARRERO
Credential	:	RN
Telephone Number	:	239-517-2578

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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