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FORT WALTON BEACH DEVELOPMENTAL CENTER
NPI 1962009019
Intermediate Care Facility, Intellectual Disabilities in Fort Walton Beach, FL

Active since October 01, 2020CLIA 10D0860494 · Waiver
1045 MAR WALT DR, FORT WALTON BEACH, FL 32547(850) 862-0108(850) 862-7103 Get Directions Write a Review

NPPES record last updated: November 18, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 18, 2020, Oct 1, 2020 (2 updates tracked since 2020).

About Fort Walton Beach Developmental Center NPPES

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

FORT WALTON BEACH DEVELOPMENTAL CENTER (NPI 1962009019) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Fort Walton Beach, Florida and active in the NPI registry since October 2020. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Carol Swanson, Vice President Of Operations, as its authorized official.

NPPES Registry Identity

NPI1962009019
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameFLORIDA MENTOR II LLC
Location Address1045 MAR WALT DRFort Walton Beach, FL 32547-6738
Mailing Address3258 Parkside Center CirTampa, FL 33619-0907 · (813) 389-8300
Phone(850) 862-0108
Fax(850) 862-7103
Organization SubpartYes
Authorized OfficialCarol SwansonVice President Of Operations · (813) 389-8300
Enumeration DateOctober 1, 2020
Last NPPES UpdateNovember 18, 20202 updates tracked since enumeration
NPPES CertifiedNovember 18, 2020
✔ NPI 1962009019 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
1045 MAR WALT DR, Fort Walton Beach, FL 32547
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Other Names 1

Doing Business AsFort Walton Beach Developmental Center

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D0860494

Florida Mentor II LLC · Fort Walton Beach, FL
Active · expires Aug 31, 2026
CLIA Number10D0860494
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorSteven Donchey
Laboratory Phone(850) 862-0108
Laboratory LocationFlorida Mentor II LLC1045 Mar Walt Dr, Fort Walton Beach, FL 32547
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Florida Mentor II LLC's NPI number?

The NPI number for Florida Mentor II LLC is 1962009019. It was assigned to this organization in the NPPES registry on October 1, 2020. The provider is doing business as Fort Walton Beach Developmental Center.

Where is Florida Mentor II LLC located?

Florida Mentor II LLC is located at 1045 Mar Walt Dr, Fort Walton Beach, FL 32547. The listed phone number is (850) 862-0108.

What is Florida Mentor II LLC's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does Florida Mentor II LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D0860494) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Florida Mentor II LLC was last updated on November 18, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.