Provider Demographics
NPI:1700200649
Name:TWO SISTERSHOMECARE # III
Entity Type:Organization
Organization Name:TWO SISTERSHOMECARE # III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-897-0734
Mailing Address - Street 1:9143 NW 117TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4147
Mailing Address - Country:US
Mailing Address - Phone:786-897-0734
Mailing Address - Fax:305-816-0202
Practice Address - Street 1:9143 NW 117TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4147
Practice Address - Country:US
Practice Address - Phone:786-897-0734
Practice Address - Fax:305-816-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10940261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL10940OtherALF LICENSE
FL1427776Medicaid