Provider Demographics
NPI:1033487418
Name:WINTER HAVEN HOSPITAL
Entity Type:Organization
Organization Name:WINTER HAVEN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THEARAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OLES
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW MI AND PSW FL
Authorized Official - Phone:863-409-5023
Mailing Address - Street 1:200 AVENUE F, N.E.
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881
Mailing Address - Country:US
Mailing Address - Phone:863-294-7056
Mailing Address - Fax:863-291-6753
Practice Address - Street 1:1201 FIRST STREET S.
Practice Address - Street 2:SWEET CENTER
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-294-7056
Practice Address - Fax:863-291-6753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1726685282N00000X
FLPSW 836282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital