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General NPI Number Information
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NPI Number | 1205219003
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Entity Type | Organization
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Legal Business Name | BANYAN COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 10720 CARIBBEAN BLVD STE 420
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City | CUTLER BAY
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State | FL
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Zip | 33189-1244
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Country | US
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Telephone | 786-293-9544
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 NW 89TH PL FL 3
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City | DORAL
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State | FL
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Zip | 33172-2431
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Country | US
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Telephone | 305-398-6100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MANUEL ANDRES FERNANDEZ
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Credential |
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Telephone | 561-213-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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