1477599975 NPI number — WINTER HAVEN HOSPITAL INC

Table of content: (NPI 1477599975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477599975 NPI number — WINTER HAVEN HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTER HAVEN HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTERS FOR BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477599975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2995 DREW ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-281-9390
Provider Business Mailing Address Fax Number:
813-635-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 AVE F NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-293-1121
Provider Business Practice Location Address Fax Number:
813-635-2613
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUBERO
Authorized Official First Name:
TAMBLYN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
MANAGER, CBO FINANCE
Authorized Official Telephone Number:
727-281-9257

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 3974 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010169900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 98943 . This is a "BC 1500" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010169903 . This is a "MEDICAID UB" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 507 . This is a "BC UB" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 060611101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060611100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223 . This is a "BCBSF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: C11283 . This is a "MEDICARE RAILROAD 1500" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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