Organization
BANYAN SOBER LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NEISHA ZAFFUTO (BUSINESS MANAGER)
(954) 746-8232
Entity
Organization
Contact information
Practice address
2500 E COMMERCIAL BLVD, SUITE D, FORT LAUDERDALE, FL 33308-4124
(954) 746-8232
(954) 746-8981
Mailing address
2500 E COMMERCIAL BLVD, SUITE D, FORT LAUDERDALE, FL 33308-4124
(954) 746-8232
(954) 746-8981
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
291U00000X
Clinical Medical Laboratory
Primary
10D2047989
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2047989
CLIA CERTIFICATE OF WAIVER
FL
Enumeration date
11/15/2012
Last updated
01/13/2014
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