Organization
BANYAN COMMUNITY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT CARRODEGUAS (CEO)
(305) 398-6100
Entity
Organization
Contact information
Practice address
1566 SW 1ST ST, SUITE 21-23, MIAMI, FL 33135-2103
(305) 642-8325
Mailing address
6100 BLUE LAGOON DR, SUITE 400, MIAMI, FL 33126-2079
(305) 398-6100
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012558503
—
FL
Enumeration date
07/14/2014
Last updated
07/28/2021
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