Organization
BANYAN GULF BREEZE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SORY (CEO)
(954) 533-7705
Entity
Organization
Contact information
Practice address
1830 HICKORY SHORES RD, GULF BREEZE, FL 32563-9143
(754) 206-8522
(850) 677-0312
Mailing address
225 N FEDERAL HWY, POMPANO BEACH, FL 33062-4319
(954) 533-7705
(954) 781-7173
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
283Q00000X
Psychiatric Hospital
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122549700
—
FL
Enumeration date
07/03/2023
Last updated
05/13/2025
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