Provider Demographics
NPI:1033770284
Name:ADVENTHEALTH POLK SOUTH INC
Entity Type:Organization
Organization Name:ADVENTHEALTH POLK SOUTH INC
Other - Org Name:ADVENTHEALTH LAKE WALES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:HENGESBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-419-2260
Mailing Address - Street 1:410 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4203
Mailing Address - Country:US
Mailing Address - Phone:863-676-1433
Mailing Address - Fax:863-297-1867
Practice Address - Street 1:410 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4203
Practice Address - Country:US
Practice Address - Phone:863-676-1433
Practice Address - Fax:863-297-1867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVENTHEALTH POLK SOUTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-27
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit