MEDICARE: DOUBLE NINE SENIORS CLUB INC.

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	311Z00000X	Custodial Care Facility	9210	FL
2	261QA0600X	Adult Day Care Clinic/Center		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851647499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUBLE NINE SENIORS CLUB INC.

Provider Business Mailing Address
First Line	:	4719 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	305-825-4459
Fax Number	:	305-825-4454

Provider Business Practice Location Address
First Line	:	4719 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4037
Country	:	US
Telephone Number	:	305-825-4459
Fax Number	:	305-825-4454

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. YOLANDA LUGONES
Credential	:
Telephone Number	:	305-775-7439

Provider Enumeration Date	:	08/01/2012
Last Update Date	:	10/18/2024

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