FORT WALTON BEACH DEVELOPMENTAL CENTER
NPI 1962009019
Intermediate Care Facility, Intellectual Disabilities in Fort Walton Beach, FL
NPI Status: Active since October 01, 2020
Contact Information
1045 MAR WALT DR
FORT WALTON BEACH, FL
ZIP 32547
Phone: (850) 862-0108
Fax: (850) 862-7103
- Organization
- Intermediate Care Facility, Intellectual...
- CLIA Number: 10D0860494
- CLIA Cert. Type: Intermediate Care Facility for Mentally Retarded
- CLIA Exp. Date: 08-31-2026
About FORT WALTON BEACH DEVELOPMENTAL CENTER
This page provides the complete NPI Profile along with additional information for Fort Walton Beach Developmental Center, a provider established in Fort Walton Beach, Florida operating as a Intermediate Care Facility, Intellectual Disabilities. The healthcare provider is registered in the NPI registry with number 1962009019 assigned on October 2020. The practitioner's primary taxonomy code is 315P00000X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Fort Walton Beach Developmental Center. The authorized official of this NPI record is Carol Swanson (Vice President Of Operations)
- NPI
- 1962009019
- Provider Legal Name
- FLORIDA MENTOR II LLC
- Other Organization Name
- FORT WALTON BEACH DEVELOPMENTAL CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1045 MAR WALT DR FORT WALTON BEACH, FL 32547
- Location Phone
- (850) 862-0108
- Location Fax
- (850) 862-7103
- Mailing Address
- 3258 PARKSIDE CENTER CIR TAMPA, FL 33619
- Mailing Phone
- (813) 389-8300
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 10-01-2020
- Last Update Date
- 11-18-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Intermediate Care Facility, Intellectual Disabilities
- Taxonomy Code
- 315P00000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- An intermediate care facility providing services for individuals with intellectual disabilities.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D0860494
- Facility Type
- Intermediate Care Facility for Mentally Retarded
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- STEVEN DONCHEY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Fort Walton Beach Developmental Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1962009019, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 51. The final step is to find the difference between that total and the next multiple of ten (60 - 51 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 51 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1962009019, enumerated as an "organization" on October 01, 2020.
The provider is located at 1045 MAR WALT DR FORT WALTON BEACH, FL 32547 and the phone number is (850) 862-0108.
Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.
