Organization
A BANYAN RESIDENCE ASSISTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG A ANDERSON (MANAGING MEMBER)
(954) 454-2345
Entity
Organization
Contact information
Practice address
100 BASE AVE E, VENICE, FL 34285-3809
(941) 412-4748
Mailing address
3107 NE 40TH CT, FORT LAUDERDALE, FL 33308-6413
(954) 454-2345
(954) 457-8242
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
APPLIED FOR IT
FL
Other
Enumeration date
08/16/2007
Last updated
12/17/2009
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