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General NPI Number Information
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NPI Number | 1780126755
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Entity Type | Organization
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Legal Business Name | BANYAN RECOVERY INSTITUTE
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 2699 STIRLING RD SUITE B-301
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-6517
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Country | US
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Telephone | 954-874-7923
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Fax |
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Provider Business Mailing Address
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Address Line | 2699 STIRLING RD SUITE B-301
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-6517
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Country | US
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Telephone | 954-874-7923
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Fax |
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Authorized Official
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Title or Position | CLAIMS SUPERVISOR
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Name | MS. CLARIBEL DELOSSANTOS
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Credential |
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Telephone | 954-874-7923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1706AD699801
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License Number State | FL
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