Healthcare Provider Details

I. General information

NPI: 1710360482
Provider Name (Legal Business Name): BANYAN COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW 2ND ST
POMPANO BEACH FL
33060-4611
US

IV. Provider business mailing address

2300 NW 89TH PL FL 3
DORAL FL
33172-2431
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-9828
  • Fax:
Mailing address:
  • Phone: 305-398-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MANUEL ANDRES FERNANDEZ
Title or Position: CEO
Credential:
Phone: 561-213-9211