A Banyan Residence Assisted Living LLC

NPI #1770775413 in Venice, Florida

Provider Information

NPI Number: 1770775413
Entity Type: Organization
Organization Name: A Banyan Residence Assisted Living LLC
Primary Specialty: Assisted Living Facility
Enumeration Date: Aug 16, 2007
Last Updated: Dec 17, 2009

Practice Location

Address: 100 BASE AVE E
City: Venice
State: Florida
ZIP Code: 34285-3809
Phone: (941) 412-4748

Authorized Official

Name: MR. GREG A ANDERSON
Title: MANAGING MEMBER
Phone: (954) 454-2345

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility	310400000X	Primary

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