Provider Demographics
NPI:1316579634
Name:BANYAN DELAWARE LLC
Entity type:Organization
Organization Name:BANYAN DELAWARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-533-7705
Mailing Address - Street 1:225 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4319
Mailing Address - Country:US
Mailing Address - Phone:888-879-4975
Mailing Address - Fax:954-781-7173
Practice Address - Street 1:21 W CLARKE AVE STE 4001
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1859
Practice Address - Country:US
Practice Address - Phone:302-315-0002
Practice Address - Fax:302-725-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE115085900Medicaid