Organization
BANYAN TREATMENT CENTER IL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SORY (CEO)
(954) 533-7705
Entity
Organization
Contact information
Practice address
2525 CABOT DR STE 300, LISLE, IL 60532-0916
(954) 781-7173
(630) 210-8164
Mailing address
225 N FEDERAL HWY, POMPANO BEACH, FL 33062-4319
(954) 781-7173
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D2101029
CLIA
IL
01
—
A-4152-0001-A
STATE LICENSE
IL
Enumeration date
09/15/2015
Last updated
05/13/2025
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