Healthcare Provider Details

I. General information

NPI: 1154998995
Provider Name (Legal Business Name): WINTER HAVEN NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 LAKE MARIAM DR
WINTER HAVEN FL
33884-0927
US

IV. Provider business mailing address

3599 W LAKE MARY BLVD
LAKE MARY FL
32746-3417
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1989
  • Fax: 863-299-6427
Mailing address:
  • Phone: 352-874-6007
  • Fax: 352-404-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA SHARPLESS
Title or Position: DIRECTOR OF ACCOUNTING
Credential:
Phone: 352-874-6007