Provider Demographics
NPI:1093322794
Name:FLORIDA MENTOR II LLC
Entity Type:Organization
Organization Name:FLORIDA MENTOR II LLC
Other - Org Name:HILLSBOROUGH COUNTY DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-389-8300
Mailing Address - Street 1:3258 PARKSIDE CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-0907
Mailing Address - Country:US
Mailing Address - Phone:813-389-8300
Mailing Address - Fax:
Practice Address - Street 1:14219 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3913
Practice Address - Country:US
Practice Address - Phone:813-971-3490
Practice Address - Fax:813-977-3471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA MENTOR II LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities