NPIMap

Organization Active NPI

Sa-PG-Winter Haven LLC

Doing business as Palm Garden of Winter Haven

  • Skilled Nursing Facility
  • Winter Haven, FL
National Provider Identifier
1730185976
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF1414096 Issued in FL
Legal business name
SA-PG-WINTER HAVEN LLC
Doing business as
Palm Garden of Winter Haven
Practice address
1120 Cypress Gardens Blvd
Winter Haven, FL 33884-1919
Phone
(863) 293-3100
Fax
(863) 291-0578
NPI assigned
Jun 22, 2005
Last updated
Jul 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Alex Paley
Title
Coo
Phone
(914) 390-4363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF1414096 FL Primary

Addresses

Primary practice location

1120 Cypress Gardens Blvd
Winter Haven, FL 33884-1919

Mailing address

1120 Cypress Gardens Blvd
Winter Haven, FL 33884-1919
Phone (863) 293-3100

Other identifiers 1

IdentifierTypeStateIssuer
025732000MedicaidFL

Other names 1

  • Palm Garden of Winter Haven Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Palm Garden of Winter Haven2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1730185976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "SA-PG-WINTER HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "PALEY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "914-390-4363",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1414096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025732000",
            "state": "FL"
        }
    ],
    "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 Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.