Healthcare Provider Details

I. General information

NPI: 1316579634
Provider Name (Legal Business Name): BANYAN DELAWARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W CLARKE AVE STE 4001
MILFORD DE
19963-1859
US

IV. Provider business mailing address

225 N FEDERAL HWY
POMPANO BEACH FL
33062-4319
US

V. Phone/Fax

Practice location:
  • Phone: 302-315-0002
  • Fax: 302-725-0030
Mailing address:
  • Phone: 888-879-4975
  • Fax: 954-781-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN SORY
Title or Position: CEO
Credential:
Phone: 954-533-7705