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General NPI Number Information
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NPI Number | 1316806011
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Entity Type | Organization
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Legal Business Name | BANYAN COLUMBIA, LLC
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 915 HOOK AVE
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-5332
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Country | US
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Telephone | 954-533-7705
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Fax | 954-781-7173
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Provider Business Mailing Address
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Address Line | 225 N FEDERAL HWY
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City | POMPANO BEACH
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State | FL
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Zip | 33062-4319
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Country | US
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Telephone | 954-533-7705
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Fax | 954-781-7173
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Authorized Official
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Title or Position | CEO
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Name | JOHN SORY
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Credential |
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Telephone | 954-533-7705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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