MEDICARE: WINTER HAVEN NURSING LLC

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
1	314000000X	Skilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1154998995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINTER HAVEN NURSING LLC

Provider Business Mailing Address
First Line	:	3599 W LAKE MARY BLVD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3417
Country	:	US
Telephone Number	:	352-874-6007
Fax Number	:	352-404-4078

Provider Business Practice Location Address
First Line	:	1801 LAKE MARIAM DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-0927
Country	:	US
Telephone Number	:	863-293-1989
Fax Number	:	863-299-6427

Authorized Official
Title or Position	:	DIRECTOR OF ACCOUNTING
Name	:	VICTORIA SHARPLESS
Credential	:
Telephone Number	:	352-874-6007

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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