Organization
WINTER HAVEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN ELBANOWSKI (CEO/CFO)
(805) 525-0305
Entity
Organization
Contact information
Practice address
546 CENTRAL AVE, FILLMORE, CA 93015-1332
(805) 524-3040
(805) 524-3040
Mailing address
715 E SANTA PAULA ST, SANTA PAULA, CA 93060-2063
(805) 525-0305
(805) 525-7776
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60945F
—
CA
Enumeration date
01/28/2006
Last updated
08/22/2020
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