Healthcare Provider Details

I. General information

NPI: 1467475376
Provider Name (Legal Business Name): WINTER HAVEN FACILITY OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/27/2023
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 LAKE ALFRED RD
WINTER HAVEN FL
33881-1432
US

IV. Provider business mailing address

2701 LAKE ALFRED RD
WINTER HAVEN FL
33881-1432
US

V. Phone/Fax

Practice location:
  • Phone: 863-298-5000
  • Fax: 863-295-9219
Mailing address:
  • Phone: 863-298-5000
  • Fax: 863-295-9219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF130470990
License Number StateFL

VIII. Authorized Official

Name: KENNETH USSERY
Title or Position: VP
Credential:
Phone: 407-571-1550