Active NPI
Panama City Developmental Center
- Mental Illness Intermediate Care Facility
- Panama City, FL
National Provider Identifier
1568461671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Intermediate Care Facility
- License
- 4053095
- Legal business name
- PANAMA CITY DEVELOPMENTAL CENTER
- Doing business as
- Pensacola Care Inc.
- Practice address
- 1407 Lincoln Dr
Panama City, FL 32401-2870 - Phone
- (850) 769-7771
- Fax
- (850) 522-8966
- NPI assigned
- Jul 20, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Phyllis Pennywell
- Title
- Administrator
- Phone
- (850) 769-7771
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Intermediate Care Facility | 310500000X | 4053095 | FL | Primary |
Addresses
Primary practice location
1407 Lincoln Dr
Panama City, FL 32401-2870
Mailing address
1407 Lincoln Dr
Panama City, FL 32401-2870
Phone (850) 769-7771
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8526900 | Medicaid | FL |
Other names 1
- Pensacola Care Inc.
National Provider Directory
National Provider Directory- Tax ID family
- Fort Walton Beach Developmental Center
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Fort Walton Beach, FL
- NPI 1649279589
-
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Tampa, FL
- NPI 1841299237
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Pensacola, FL
- NPI 1841299450
-
- Mental Illness Intermediate Care Facility
- Tallahassee, FL
- NPI 1609875160
Locations
1407 Lincoln Dr
Panama City, FL 32401
Phone (850) 769-7636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121817600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1568461671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1407 LINCOLN DR",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324012870",
"telephone_number": "850-769-7771",
"fax_number": "850-522-8966"
},
{
"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": "850-769-7771",
"fax_number": "850-522-8966"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PANAMA CITY DEVELOPMENTAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2005-07-20",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "PENNYWELL",
"authorized_official_first_name": "PHYLLIS",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "850-769-7771"
},
"taxonomies": [
{
"code": "310500000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Mental Illness",
"state": "FL",
"license": "4053095",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8526900",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pensacola Care Inc.",
"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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.