Organization
BANYAN MOORESVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN SORY (CEO)
(954) 533-7705
Entity
Organization
Contact information
Practice address
291 COMMERCIAL DR, MOORESVILLE, NC 28115-7870
(954) 533-7705
(954) 781-7173
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
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
05/30/2024
Last updated
05/30/2024
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