Organization · Type 2 NPI

Florida Mentor II LLC

Intellectual Disabilities Intermediate Care Facility · Fort Walton Beach, FL

NPI number 1962009019 Active

Practice location

1045 Mar Walt Dr
Fort Walton Beach, FL 32547-6738

Call (850) 862-0108 Map

Fax (850) 862-7103

Mailing address

3258 Parkside Center Cir
Tampa, FL 33619-0907

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	None listed

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

NPI record

NPI: 1962009019
Entity type: Organization (Type 2)
Issued: Oct 1, 2020
Last updated: Nov 18, 2020
Status: Active
Subpart: Yes of Florida Mentor II LLC

Other names

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Fort Walton Beach Developmental Center · doing business as

Authorized official

Carol Swanson
Vice President of Operations
(813) 389-8300

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1962009019

Florida Mentor II LLC's National Provider Identifier is 1962009019, issued on Oct 1, 2020. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Fort Walton Beach, FL. The record was last updated on Nov 18, 2020.