Banyan Sober Living of Michigan

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

BANYAN SOBER LIVING OF MICHIGAN

Practice address

1023 Washtenaw Rd
Ypsilanti, MI 48197-2161

Phone

(231) 233-8474

Fax

(734) 264-0732

NPI assigned

Apr 21, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mackenzie Koonce

Title

Coo

Phone

(231) 233-8474

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1245650035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 272",
            "city": "MILFORD",
            "state": "MI",
            "postal_code": "483810272",
            "telephone_number": "231-233-8474",
            "fax_number": "734-264-0732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 WASHTENAW RD",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972161",
            "telephone_number": "231-233-8474",
            "fax_number": "734-264-0732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN SOBER LIVING OF MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-21",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "KOONCE",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "231-233-8474"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David E Baker, M.D.
• Misha Bakhsh
• Sneha Balachander, LMSW
• Claudia Patrice Mellor Balfe, PA-C
• Jennifer Bancroft
• Amnee Ibrahim Barakat, OTR/L
• Quintina Sheree Barber
• Abigail Vertalka Barden, CRNA
• Yolanda M Barefield
• Tasfia Bari

• Clinical Medical Laboratory in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.