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NPI Code Detail

MEDICARE: FAMILY EXTENDED CARE OF WINTER HAVEN, INC.

MEDICARE: FAMILY EXTENDED CARE OF WINTER HAVEN, 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
1310400000XAssisted Living FacilityAL8947FL

Other Identifiers

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

General Provider Information

NPI Number : 1730385246
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY EXTENDED CARE OF WINTER HAVEN, INC.
Provider Business Mailing Address
First Line : 625 OVERLOOK DR
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-1626
Country : US
Telephone Number : 863-324-2212
Fax Number : 863-318-8400
Provider Business Practice Location Address
First Line : 625 OVERLOOK DR
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-1626
Country : US
Telephone Number : 863-324-2212
Fax Number : 863-318-8400
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : MRS. MARY PARRETT
Credential :
Telephone Number : 941-342-0566
Provider Enumeration Date : 06/22/2007
Last Update Date : 08/22/2020

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Practice Location Address:
625 OVERLOOK DR
WINTER HAVEN, FL
33884-1626
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Practice Fax: 863-326-9432
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WINTER HAVEN, FL
33884-1626
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Practice Fax: 863-326-9432
1528183647 — WENDY JEANNE SANTIAGO PTA
Practice Location Address:
625 OVERLOOK DR
WINTER HAVEN, FL
33884-1626
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1548565005 — MARY KRISTINA MATHIS M.A./CCC-SLP
Practice Location Address:
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WINTER HAVEN, FL
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Practice Fax:
1144633918 — LYNN HARWELL OTR
Practice Location Address:
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