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Support Independent Living
Developmental Disabilities Clinic/Center in Fort Walton Beach, Florida
NPI 1306590260

Support Independent Living is a Developmental Disabilities Clinic/Center based in Fort Walton Beach, FL and is specialized in Developmental Disabilities. Support Independent Living practices in Fort Walton Beach, FL. The NPI Number for Support Independent Living is 1306590260 and holds a License No. (Florida).

The current practice location address for Support Independent Living is 11 Racetrack Rd Ne Ste C2, Fort Walton Beach, FL and can be reached out via phone at 850-259-7190.

Location: 11 Racetrack Rd Ne Ste C2, Fort Walton Beach, FL, 32547-1867
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1306590260
Provider Name
Support Independent Living
Credential
Provider Entity Type
Organization
Address
11 Racetrack Rd Ne Ste C2, Fort Walton Beach, FL, 32547-1867
Phone Number
850-259-7190
Fax Number
Provider Enumeration Date
02/09/2022
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
684509696 05 FL
institution
Provider Business Practice Location Address Details
Address
11 Racetrack Rd Ne Ste C2
City
Fort Walton Beach
State
Florida
Zip
32547-1867
Phone Number
850-259-7190
Fax Number
person
Provider Business Mailing Address Details
Address
11 Racetrack Rd Ne Ste C2
City
Fort Walton Beach
State
Florida
Zip
32547-1867
Phone Number
850-259-7190
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Developmental Disabilities
Taxonomy
261QD1600X
License No.
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Definition
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
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