BANYAN GULF BREEZE LLC NPI 1386321180

NPI Information

  • NPI: 1386321180
  • Provider Name: BANYAN GULF BREEZE LLC
  • Classification: Substance Abuse Rehabilitation Facility - 324500000X
  • Entity Type: Organization
  • CLIA Number: 10D2291588
  • Address: 1830 HICKORY SHORES RD
    GULF BREEZE, FL
    ZIP 32563
  • Phone: (754) 206-8522

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NPI Details

BANYAN GULF BREEZE LLC is a substance abuse rehabilitation facility in Gulf Breeze, FL. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. BANYAN GULF BREEZE LLC NPI is 1386321180. The provider is registered as an organization entity type.

The provider's business location address is:

1830 HICKORY SHORES RD
GULF BREEZE, FL
ZIP 32563-143
Phone: (754) 206-8522
Fax: (850) 677-0312

The provider's authorized official is John Sory .
The authorized official title is Ceo and has the following contact phone number (954) 533-7705.

The CLIA number assigned to this NPI record is 10D2291588 - other - sud treatment center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/3/2023 and was last updated on 5/13/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1283Q00000XPsychiatric HospitalNo
2261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
3324500000XSubstance Abuse Rehabilitation FacilityYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1122549700MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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