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
4900 W OAKLAND PARK BLVD STE 101, LAUDERDALE LAKES, FL 33313-1555
(305) 398-6100
Mailing address
6100 BLUE LAGOON DR STE 400, MIAMI, FL 33126-2080
(305) 398-6100
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014042600
—
FL
Enumeration date
07/28/2021
Last updated
01/21/2023
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