Organization
BANYAN COMMUNITY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL ANDRES FERNANDEZ (CEO)
(561) 213-9211
Entity
Organization
Contact information
Practice address
4900 W OAKLAND PARK BLVD FL 3, LAUDERDALE LAKES, FL 33313-7500
(305) 398-6100
Mailing address
2300 NW 89TH PL FL 3, DORAL, FL 33172-2431
(305) 398-6100
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013881915
—
FL
05
—
013881916
—
FL
05
—
014042500
—
FL
Enumeration date
08/18/2015
Last updated
04/15/2025
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