| Banyan Sober Living, Inc. | |
|
2500 E Commercial Blvd Suite D Fort Lauderdale FL 33308-4124 | |
| (954) 746-8232 | |
| (954) 746-8981 |
| Full Name | Banyan Sober Living, Inc. |
|---|---|
| Speciality | Clinical Medical Laboratory |
| Location | 2500 E Commercial Blvd, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Neisha Zaffuto (BUSINESS MANAGER) |
| Authorized Official Contact | 9547468232 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banyan Sober Living, Inc. 2500 E Commercial Blvd Suite D Fort Lauderdale FL 33308-4124 Ph: (954) 746-8232 | Banyan Sober Living, Inc. 2500 E Commercial Blvd Suite D Fort Lauderdale FL 33308-4124 Ph: (954) 746-8232 |
| NPI Number | 1285978338 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 01/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285978338 | NPI | - | NPPES |
| 10D2047989 | Other | FL | CLIA CERTIFICATE OF WAIVER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 291U00000X | Clinical Medical Laboratory | 10D2047989 (Florida) | Primary |
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