Active NPI
A Banyan Residence at Wildwood, LLC
- Assisted Living Facility
- Oxford, FL
National Provider Identifier
1083201891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- Legal business name
- A BANYAN RESIDENCE AT WILDWOOD, LLC
- Practice address
- 12427 County Road 101
Oxford, FL 34484-2941 - Phone
- (954) 854-8895
- Fax
- (941) 412-4749
- NPI assigned
- Dec 28, 2020
- Last updated
- Dec 28, 2020
- Organization subpart
- Yes
- Parent organization
- A BANYAN RESIDENCE ASSISTED LIVING LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Greg Anderson
- Title
- Managing Member
- Phone
- (954) 536-4066
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | NU | Primary |
Addresses
Primary practice location
12427 County Road 101
Oxford, FL 34484-2941
Mailing address
2515 Sherman Oak Dr
North Port, FL 34289-2390
Phone (941) 249-0456
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Oxford | Direct |
National Provider Directory
National Provider Directory- Part of
- A Banyan Residence Assisted Living LLC
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Assisted Living Facility
- Venice, FL
- NPI 1770775413
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609113600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1609113600000",
"number": "1083201891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2515 SHERMAN OAK DR",
"city": "NORTH PORT",
"state": "FL",
"postal_code": "342892390",
"telephone_number": "941-249-0456",
"fax_number": "941-412-4749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12427 COUNTY ROAD 101",
"city": "OXFORD",
"state": "FL",
"postal_code": "344842941",
"telephone_number": "954-854-8895",
"fax_number": "941-412-4749"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "A BANYAN RESIDENCE AT WILDWOOD, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "A BANYAN RESIDENCE ASSISTED LIVING LLC",
"enumeration_date": "2020-12-28",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A",
"authorized_official_last_name": "ANDERSON",
"authorized_official_first_name": "GREG",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "954-536-4066"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Oxford",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "12427 County Road 101",
"city": "Oxford",
"state": "FL",
"country_code": "US",
"postal_code": "344842941",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Oxford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.