Basic Information
| Provider Information | |||||||||
| NPI: | 1033487418 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINTER HAVEN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 AVENUE F, N.E. | ||||||||
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| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632947056 | ||||||||
| FaxNumber: | 8632916753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 FIRST STREET S. | ||||||||
| Address2: | SWEET CENTER | ||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632947056 | ||||||||
| FaxNumber: | 8632916753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | OLES | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH THEARAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8634095023 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW MI AND PSW FL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | L1726685 | MI | N | Hospitals | General Acute Care Hospital | 282N00000X | PSW 836 | FL | Y | Hospitals | General Acute Care Hospital |
No ID Information.