# WINTER HAVEN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154392181
- **Authorized official:** KATHLEEN ELBANOWSKI (CEO/CFO)
- **Authorized official phone:** (805) 525-0305

## Contact information

- **Practice address:** 546 CENTRAL AVE, FILLMORE, CA 93015-1332
- **Practice address phone:** (805) 524-3040
- **Practice address fax:** (805) 524-3040
- **Mailing address:** 715 E SANTA PAULA ST, SANTA PAULA, CA 93060-2063
- **Mailing address phone:** (805) 525-0305
- **Mailing address fax:** (805) 525-7776

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | — | CA | Yes |

## Other

- **Enumeration date:** 01/28/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC60945F | — | CA |