Active NPI
Palm Garden of Winter Haven LLC
- Skilled Nursing Facility
- Winter Haven, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1414096
- Legal business name
- PALM GARDEN OF WINTER HAVEN LLC
- Practice address
- 1120 Cypress Gardens Blvd
Winter Haven, FL 33884-1919 - Phone
- (863) 293-3100
- Fax
- (863) 291-0578
- NPI assigned
- Sep 10, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Morris H. Miller
- Title
- Authorized Representative
- Phone
- (941) 952-9411
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1414096 | FL | Primary |
Addresses
Primary practice location
1120 Cypress Gardens Blvd
Winter Haven, FL 33884-1919
Mailing address
2033 Main St
Suite 302
Sarasota, FL 34237-6056
Phone (941) 952-9411
Other names 1
- Palm Garden of Winter Haven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131203000206 | FL | Part A Provider - Skilled Nursing Facility | 6002042785 | Practice locations: Winter Haven, FL |
Skilled nursing facility certification: CCN 105566
- Legal name
- PALM GARDEN OF WINTER HAVEN LLC
- Doing business as
- PALM GARDEN OF WINTER HAVEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 9, 1987
- Last certification
- Jun 20, 2024
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Palm Garden
- Most recent change of ownership
- Nov 1, 2013
- Organization structure
- LLC
- Incorporated
- May 23, 2013 in DE
- Enrollment address
- 1120 Cypress Gardens Blvd
Winter Haven, FL 33884-1919 - Nursing home name
- PALM GARDEN OF WINTER HAVEN
- Affiliated entity
- PALM GARDEN HEALTH AND REHABILITATION
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Palm Garden of Winter Haven
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 9, 1987
- Medicare certification status
- Active
- Certified beds
- 120
- Chain
- Palm Garden Health and Rehabilitation
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Palm Garden of Winter Haven
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- Winter Haven, FL
- NPI 1730185976
Locations
1120 Cypress Gardens Blvd
Winter Haven, FL 33884
Phone (863) 293-1300
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 13
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffrey D Bomberger | Corporate Officer | Oct 1, 2014 | |
| Waseem J David | Operational/Managerial Control | Oct 1, 2024 | |
| Adp of the SNF | Oct 1, 2024 | ||
| Robert Greene | Corporate Officer | Oct 1, 2014 | |
| Pgwin Re, LLC | 5% Or Greater Security Interest | Jul 29, 2024 | 100% |
| Adp of the SNF | Jul 29, 2024 | ||
| James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001, | 5% Or Greater Indirect Ownership Interest | Dec 23, 2014 | 38% |
| Adp of the SNF | Nov 1, 2013 | ||
| Tunya Washington | Operational/Managerial Control | Apr 4, 2024 | |
| Adp of the SNF | Mar 14, 2025 | ||
| James O. McCarver Residuary Trust Share U/a Dated 06/22/2001 | 5% Or Greater Indirect Ownership Interest | Dec 23, 2014 | 8% |
| James Chalmers | Corporate Officer | Jan 1, 2015 | |
| Regions Bank | 5% Or Greater Mortgage Interest | Nov 1, 2013 | 100% |
| 5% Or Greater Security Interest | Nov 1, 2013 | 100% | |
| Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E | 5% Or Greater Indirect Ownership Interest | Nov 1, 2013 | 48% |
| Adp of the SNF | Nov 1, 2013 | ||
| Patsy McCarver | 5% Or Greater Indirect Ownership Interest | Nov 1, 2013 | 50% |
| Palm Garden Healthcare Holdings, LLC | 5% Or Greater Direct Ownership Interest | Nov 1, 2013 | 50% |
| Palm Healthcare Management, LLC | Adp of the SNF | Mar 14, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Hospitalist Physician
- Winter Haven, FL
- NPI 1295197416
Adp of the SNF, Operational/Managerial Control
Facilities with the same owner 13
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Aventura, FL
- NPI 1922432772
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Clearwater, FL
- NPI 1457786410
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Gainesville, FL
- NPI 1093140055
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Jacksonville, FL
- NPI 1831524883
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Largo, FL
- NPI 1740615798
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Ocala, FL
- NPI 1114352168
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Orlando, FL
- NPI 1669807616
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Largo, FL
- NPI 1316372360
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Port St Lucie, FL
- NPI 1770918724
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Ruskin, FL
- NPI 1588098263
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Tampa, FL
- NPI 1053746008
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
-
- Skilled Nursing Facility
- Vero Beach, FL
- NPI 1265867212
James O. McCarver Qtip Business Marital Trust U/a Dated June 22, 2001,, James O. McCarver Residuary Trust Share U/a Dated 06/22/2001, Palm Garden Healthcare Holdings, LLC, Patsy E. McCarver Trust U/a Dated June 22, 2001 As Amended, Patsy E
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378771200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1386115200000",
"number": "1437584489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2033 MAIN ST",
"address_2": "SUITE 302",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342376056",
"telephone_number": "941-952-9411",
"fax_number": "941-952-9331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 CYPRESS GARDENS BLVD",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338841919",
"telephone_number": "863-293-3100",
"fax_number": "863-291-0578"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PALM GARDEN OF WINTER HAVEN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-09-10",
"last_updated": "2013-12-04",
"status": "A",
"authorized_official_last_name": "MILLER",
"authorized_official_first_name": "MORRIS",
"authorized_official_middle_name": "H.",
"authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
"authorized_official_telephone_number": "941-952-9411"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "1414096",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Palm Garden of Winter Haven",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.