=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952074650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANYAN COMMUNITY HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2021
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3850 W FLAGLER ST
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-774-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 NW 89TH PL FL 3
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-398-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MANUEL ANDRES FERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-213-9211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------