FLORIDA MENTOR II LLC NPI 1962009019

NPI Information

  • NPI: 1962009019
  • Provider Name: FLORIDA MENTOR II LLC
  • Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
  • Entity Type: Organization
  • Doing Business As: FORT WALTON BEACH DEVELOPMENTAL CENTER
  • CLIA Number: 10D0860494
  • Address: 1045 MAR WALT DR
    FORT WALTON BEACH, FL
    ZIP 32547
  • Phone: (850) 862-0108

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NPI Details

FLORIDA MENTOR II LLC is an intermediate care facility mentally retarded in Fort Walton Beach, FL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. FLORIDA MENTOR II LLC NPI is 1962009019. The provider is registered as an organization entity type.
The provider Is Doing Business As Fort Walton Beach Developmental Center.

The provider's business location address is:

1045 MAR WALT DR
FORT WALTON BEACH, FL
ZIP 32547-738
Phone: (850) 862-0108
Fax: (850) 862-7103

The provider's authorized official is Carol Swanson .
The authorized official title is Vice President Of Operations and has the following contact phone number (813) 389-8300.

The CLIA number assigned to this NPI record is 10D0860494 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/1/2020 and was last updated on 11/18/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1315P00000XIntermediate Care Facility, Intellectual DisabilitiesYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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