Provider Demographics
NPI:1316096266
Name:WINTER HAVEN HOSPITAL INC
Entity type:Organization
Organization Name:WINTER HAVEN HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-293-1121
Mailing Address - Street 1:200 AVENUE F NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:863-293-1121
Mailing Address - Fax:863-291-6719
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:863-291-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3974273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98943OtherBC 1500
FL010169903Medicaid
FLZ23OtherBC REH
FL507OtherBC UB
FL010169900Medicaid
FL507OtherBC UB
FLZ23OtherBC REH