Provider Demographics
NPI:1851647499
Name:DOUBLE NINE SENIORS CLUB INC.
Entity Type:Organization
Organization Name:DOUBLE NINE SENIORS CLUB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-838-8149
Mailing Address - Street 1:4719 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-825-4459
Mailing Address - Fax:305-825-4454
Practice Address - Street 1:4719 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4037
Practice Address - Country:US
Practice Address - Phone:305-825-4459
Practice Address - Fax:305-825-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA0600X
FL9210311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care