Provider Demographics
NPI:1467475376
Name:WINTER HAVEN FACILITY OPERATIONS, LLC
Entity Type:Organization
Organization Name:WINTER HAVEN FACILITY OPERATIONS, LLC
Other - Org Name:CONSULATE HEALTH CARE OF WINTER HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:USSERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:2701 LAKE ALFRED RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1432
Mailing Address - Country:US
Mailing Address - Phone:863-298-5000
Mailing Address - Fax:863-295-9219
Practice Address - Street 1:2701 LAKE ALFRED RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1432
Practice Address - Country:US
Practice Address - Phone:863-298-5000
Practice Address - Fax:863-295-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF130470990314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008043400Medicaid
FL0319724-00Medicaid
FL0319724-00Medicaid
5910350001Medicare NSC