Florida Mentor II LLC
Intermediate Care Facility, Intellectual Disabilities in Fort Walton Beach, FL. Organization (NPI-2).
NPI number1962009019
StatusActive
Last updated in NPPESNov 18, 2020
Details
- NPI
- 1962009019
- Entity type
- Organization (NPI-2)
- Legal business name
- Florida Mentor II LLC
- Organization subpart
- Yes
- Enumeration date
- Oct 1, 2020
- Certification date
- Nov 18, 2020
- Last updated
- Nov 18, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | – | – | Yes |
Other names
- Fort Walton Beach Developmental Center (Doing Business As)
Practice location
1045 Mar Walt DrFort Walton Beach, FL 32547-6738
Phone 850-862-0108 · Fax 850-862-7103
Mailing address
3258 Parkside Center CirTampa, FL 33619-0907
Phone 813-389-8300
Authorized official
Carol Swanson
Vice President Of Operations
8133898300
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