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NPI Code Detail

MEDICARE: BANYAN PALM SPRINGS LLC

MEDICARE: BANYAN PALM SPRINGS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283Q00000XPsychiatric Hospital
2324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1851932214
Entity Type Code : Organization
Provider Name (Legal Business Name) : BANYAN PALM SPRINGS LLC
Provider Business Mailing Address
First Line : 225 N FEDERAL HWY
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33062-4319
Country : US
Telephone Number : 954-781-7173
Fax Number : 954-781-7173
Provider Business Practice Location Address
First Line : 67580 JONES RD
Second Line :
City : CATHEDRAL CITY
State : CA
Zip : 92234-6401
Country : US
Telephone Number : 760-616-5800
Fax Number : 760-673-7443
Authorized Official
Title or Position : CEO
Name : JOHN SORY
Credential :
Telephone Number : 954-533-7705
Provider Enumeration Date : 10/07/2019
Last Update Date : 05/13/2025

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