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SUPPORT INDEPENDENT LIVING
NPI 1306590260
Clinic/Center - Developmental Disabilities in Fort Walton Beach, FL

Active since February 09, 2022
11 RACETRACK RD NE STE C2, FORT WALTON BEACH, FL 32547(850) 259-7190 Get Directions Write a Review

NPPES record last updated: February 9, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Support Independent Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SUPPORT INDEPENDENT LIVING (NPI 1306590260) is a healthcare organization registered as a developmental disabilities in Fort Walton Beach, Florida and active in the NPI registry since February 2022. The organization lists Brenda F Marrier, Owner, as its authorized official.

NPPES Registry Identity

NPI1306590260
Entity TypeOrganization
Primary Taxonomy261QD1600X
Legal Business NameSUPPORT INDEPENDENT LIVING
Location Address11 RACETRACK RD NE STE C2Fort Walton Beach, FL 32547-1867
Mailing Address11 Racetrack Rd Ne Ste C2Fort Walton Beach, FL 32547-1867 · (850) 259-7190 · Fax (850) 862-4849
Phone(850) 259-7190
Organization SubpartNo
Authorized OfficialBrenda F MarrierOwner · (850) 259-7190
Enumeration DateFebruary 9, 2022
NPPES CertifiedFebruary 9, 2022
✔ NPI 1306590260 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Developmental DisabilitiesAmbulatory Health Care Facilities
Taxonomy Code261QD1600X
Definition
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
11 RACETRACK RD NE STE C2, Fort Walton Beach, FL 32547
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Other Names 1

Doing Business AsSupport Independent Living

Other Identifiers 1

Medicaid684509696FL

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Support Independent Living's NPI number?

The NPI number for Support Independent Living is 1306590260. It was assigned to this organization in the NPPES registry on February 9, 2022.

Where is Support Independent Living located?

Support Independent Living is located at 11 Racetrack Rd NE Ste C2, Fort Walton Beach, FL 32547. The listed phone number is (850) 259-7190.

What is Support Independent Living's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Developmental Disabilities, with taxonomy code 261QD1600X.

When was this NPI record last updated?

The NPPES record for Support Independent Living was last updated on February 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.