PENSACOLA DEVELOPMENTAL CENTER (NPI# 1841299450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841299450 |
| Entity Type | Organization |
| Organization Name | PENSACOLA DEVELOPMENTAL CENTER |
| Other Organization Name | PENSACOLA CARE, INC |
| Practice Address |
1 Villa Dr Pensacola FL 32506-5535 |
| Practice Telephone | 8504532323 |
| Mailing Telephone | 8504532323 |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. WAYNE DANIELS (ADMINISTRATOR) |
| Authorized Official Telephone | 8504532323 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4058096 | FL | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Pensacola Care, INC | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PENSACOLA DEVELOPMENTAL CENTER | 1 Villa Dr, Pensacola, FL 32506-5535 |
| Street Address |
1 VILLA DR |
| City | PENSACOLA |
| State | FL |
| Zip Code | 32506-5535 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780281824 | Florida Mentor II LLC | Intermediate Care Facility, Mentally Retarded | 1 Villa Dr, Pensacola, FL 32506-5535 | 2020-10-01 |
| 1902857923 | William W Belk | Family Medicine | 1 Villa Dr, Pensacola, FL 32506-5535 | 2006-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093332942 | Abigail Irene Dudek | Behavior Technician | 6800 West Us-98, Pensacola, FL 32506 | 2020-06-26 |
| 1053957274 | Melissa Marie Swango | Technician | 3 Usher Cir, Pensacola, FL 32506 | 2019-11-22 |
| 1215479506 | Kerry Jo Pham | Advanced Practice Midwife | 225 N New Warrington Rd, Pensacola, FL 32506 | 2016-11-17 |
| 1750761375 | Congleton Eye Care, LLC | Optometrist | 4600 Mobile Hwy, Suite 122, Pensacola, FL 32506 | 2015-06-09 |
| 1033312293 | Rogelio Tridanio Martinez Sr. | Pain Medicine | 4806 Mobile Highway, Suite D, Pensacola, FL 32506 | 2007-06-06 |
| 1215023726 | Martha Goff | Pharmacist | 50 S. Blue Angel Parkway, Pensacola, FL 32506 | 2006-10-04 |
| 1881703635 | John Daniel Hodge | Dentist | 4800 W Fairfield Dr, Pensacola, FL 32506 | 2006-08-29 |
| 1417066275 | Fairfield Dental Center | Dentist | 4800 W. Fairfield Drive, Pensacola, FL 32506 | 2006-08-29 |
| 1942277793 | Phillip Martine Drlicka | Dentist | 901 N Warrington Rd, Pensocola, FL 32506 | 2006-03-01 |
| 1083694186 | Lester Shawn Bowling | Internal Medicine | 321 South Fairfield Dr, Pensacola, FL 32506 | 2006-01-17 |
| Find all providers in zip 32506 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336767128 | Marcus S Jackson Sr. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5615 Shell Rd, Pensacola, FL 32503-7825 | 2020-07-08 |
| 1912499336 | Dne Direct Care Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1602 Governors Dr Apt 1623, Pensacola, FL 32514-9435 | 2018-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518568294 | Open Skyes Family Care Home, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5600 Sw 36th St, West Park, FL 33023-6106 | 2020-11-08 |
| 1124628565 | Rachelle Homehealth Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8539 Gate Pkwy W Unit 9134, Jacksonville, FL 32216-1037 | 2020-10-26 |
| 1497368203 | Careola LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3248 Landing Vw, Tavares, FL 32778-2035 | 2020-08-31 |
| 1982218764 | The Home W/ Guiding Hands | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1256 N Florida Ave, Tarpon Springs, FL 34689-2004 | 2020-08-31 |
| 1306459359 | Joy-little Enterprise LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9148 Ridge Blvd, Jacksonville, FL 32208-1265 | 2020-08-28 |
| 1720691082 | Ohana In Home Senior Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 421 W Georgia St, Tallahassee, FL 32301-1011 | 2020-08-26 |
| 1003428467 | Pamella Omelda Odoms-brown | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 541 Shirley Dr., Apopka, FL 32712 | 2020-08-18 |
| 1831700020 | Mikerline Lyns | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10941 Winding Creek Ln, Boca Raton, FL 33428-5664 | 2020-08-12 |
| 1902416993 | Faith Care Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3800 Inverrary Blvd Ste 408d, Lauderhill, FL 33319-4359 | 2020-08-04 |
| 1063020188 | Kristine Kaiser Cravener | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1095 Beckman Dr, South Daytona, FL 32119-2499 | 2020-07-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.