NPIMap

Organization Active NPI

Florida Mentor II LLC

  • Intellectual Disabilities Intermediate Care Facility
  • Panama City, FL
National Provider Identifier
1144827296
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
FLORIDA MENTOR II LLC
Practice address
1407 Lincoln Dr
Panama City, FL 32401-2870
Phone
(850) 769-7636
Fax
(850) 522-8966
NPI assigned
Oct 1, 2020
Organization subpart
Yes
Parent organization
FLORIDA MENTOR II LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carol Swanson
Title
Vice President of Operations
Phone
(813) 389-8300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

1407 Lincoln Dr
Panama City, FL 32401-2870

Mailing address

3258 Parkside Center Cir
Tampa, FL 33619-0907
Phone (813) 389-8300

Other names 1

  • Panama City Developmental Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0726625Florida Mentor II LLC1407 Lincoln Dr, Panama City, FL 32401Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Florida Mentor II LLC12 organizations share this tax ID, including this one
Part of
Florida Mentor II LLC

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1144827296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3258 PARKSIDE CENTER CIR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336190907",
            "telephone_number": "813-389-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 LINCOLN DR",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012870",
            "telephone_number": "850-769-7636",
            "fax_number": "850-522-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA MENTOR II LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA MENTOR II LLC",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS",
        "authorized_official_telephone_number": "813-389-8300"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panama City Developmental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.