MEDICARE: BANJUL HARVEY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QH0100X	Health Service Clinic/Center
4	261QM0855X	Adolescent and Children Mental Health Clinic/Center
5	385H00000X	Respite Care
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518813187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANJUL HARVEY CENTER LLC

Provider Business Mailing Address
First Line	:	3933 E EDNA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2127
Country	:	US
Telephone Number	:	650-420-9888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3933 E EDNA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2127
Country	:	US
Telephone Number	:	650-420-9888
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	MS. JULIET BAVUGA
Credential	:	RN
Telephone Number	:	650-420-9888

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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