FLORIDA MENTOR II LLC (NPI# 1962009019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962009019 |
| Entity Type | Organization |
| Organization Name | FLORIDA MENTOR II LLC |
| Practice Address |
1045 Mar Walt Dr Fort Walton Beach FL 32547-6738 |
| Mailing Address |
3258 Parkside Center Cir Tampa FL 33619-0907 |
| Practice Telephone | 8508620108 |
| Practice Fax Number | 8508627103 |
| Mailing Telephone | 8133898300 |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | CAROL SWANSON (VICE PRESIDENT OF OPERATIONS) |
| Authorized Official Telephone | 8133898300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827288 | Florida Mentor II LLC | Intermediate Care Facility, Mentally Retarded | 455 Appleyard Dr, Tallahassee, FL 32304-2808 | 2020-10-01 |
| 1780281824 | Florida Mentor II LLC | Intermediate Care Facility, Mentally Retarded | 1 Villa Dr, Pensacola, FL 32506-5535 | 2020-10-01 |
| 1144827296 | Florida Mentor II LLC | Intermediate Care Facility, Mentally Retarded | 1407 Lincoln Dr, Panama City, FL 32401-2870 | 2020-10-01 |
| 1093322794 | Florida Mentor II LLC | Intermediate Care Facility, Mentally Retarded | 14219 Bruce B Downs Blvd, Tampa, FL 33613-3913 | 2020-09-26 |
| Street Address |
1045 MAR WALT DR |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6738 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952919557 | The Vinglo House LLC | Intermediate Care Facility, Mentally Retarded | 1862 Finn Hill Dr, Boynton Beach, FL 33426-9329 | 2020-07-20 |
| 1487290730 | Noal Group Home, Inc | Intermediate Care Facility, Mentally Retarded | 13379 Key Lime Blvd, West Palm Beach, FL 33412-2150 | 2019-11-21 |
| 1770055980 | National Mentor Healthcare LLC | Intermediate Care Facility, Mentally Retarded | 1275 N Rainbow Loop, Lecanto, FL 34461-8893 | 2018-12-28 |
| 1871993899 | Diomar Anover | Intermediate Care Facility, Mentally Retarded | 17812 Wendy Sue Ave, Hudson, FL 34667-5917 | 2014-08-27 |
| 1972856011 | The Mentor Network | Intermediate Care Facility, Mentally Retarded | 1725 Fifth St, Daytona Beach, FL 32117-5107 | 2012-10-25 |
| 1366798290 | Barc Housing Inc. | Intermediate Care Facility, Mentally Retarded | 2750 Sw 75th Ave, Davie, FL 33314-1008 | 2012-07-30 |
| 1255658365 | 98 | Intermediate Care Facility, Mentally Retarded | 11314 Mahopac Rd, Weeki Wachee, FL 34614-3562 | 2010-04-28 |
| 1245404250 | Marcia A. Howell | Intermediate Care Facility, Mentally Retarded | 17305 Blooming Fields Dr, Land O Lakes, FL 34638-7222 | 2008-04-22 |
| 1497928774 | New Vue LLC Dba Key Pine Village | Intermediate Care Facility, Mentally Retarded | 6457 W Norvell Bryant Hwy, Crystal River, FL 34429-9413 | 2008-04-08 |
| 1558533372 | Res-care Premier, Inc. | Intermediate Care Facility, Mentally Retarded | 12981 Sw 52nd St, Fort Lauderdale, FL 33330-2731 | 2008-04-01 |
| Find all providers with the same taxonomy | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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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.