Provider Demographics
NPI:1417175860
Name:SPRING HAVEN RETIREMENT, LLC
Entity Type:Organization
Organization Name:SPRING HAVEN RETIREMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-293-0072
Mailing Address - Street 1:1225 HAVENDALE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1349
Mailing Address - Country:US
Mailing Address - Phone:863-293-0072
Mailing Address - Fax:863-294-6285
Practice Address - Street 1:1225 HAVENDALE BLVD NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1349
Practice Address - Country:US
Practice Address - Phone:863-293-0072
Practice Address - Fax:863-294-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5504310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility