OrganizationActive
Florida Mentor II LLC
NPI 1962009019 · Intellectual Disabilities Intermediate Care Facility · Fort Walton Beach, FL
Provider details
- NPI number
- 1962009019
- Entity type
- Organization
- Primary specialty
- Intellectual Disabilities Intermediate Care FacilityNursing & Custodial Care Facilities
- Parent organization
- Florida Mentor II LLC
- Organization subpart
- Yes
- Authorized official
- Carol Swanson, Vice President of Operations(813) 389-8300
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
Established profile(63/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1045 Mar Walt Dr
Fort Walton Beach, FL 32547-6738
Phone: (850) 862-0108
Fax: (850) 862-7103
Approximate (ZIP-level) locationGet directions
Mailing address
3258 Parkside Center Cir
Tampa, FL 33619-0907
Other names (DBA / former)
- Doing business as
- Fort Walton Beach Developmental Center
Registry dates
- Enumerated
- 2020-10-01
- Last updated
- 2020-11-18
- Certified
- 2020-11-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.