Banyan Treatment Center Il, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

BANYAN TREATMENT CENTER IL, LLC

Practice address

2525 Cabot Dr Ste 300
Lisle, IL 60532-0916

Phone

(954) 781-7173

Fax

(630) 210-8164

NPI assigned

Sep 15, 2015

Last updated

May 13, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Sory

Title

Ceo

Phone

(954) 533-7705

Specialties & licenses 2

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew Paul Atkinson, LCPC

  • Professional Counselor
  • Naperville, IL
  • NPI 1487226734
  NPD (past)
• Patricia Badway, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Naperville, IL
  • NPI 1518525476
  NPD (past)
• Meghan Hagan, FNP

  • Family Nurse Practitioner
  • Olympia Fields, IL
  • NPI 1326412941
  NPD (past)
• Susan K Mantell, MD

  • Family Medicine Physician
  • Philo, IL
  • NPI 1881651461
  NPD (past)
• Heidi Wagner

  • Family Nurse Practitioner
  • Willowbrook, IL
  • NPI 1447702147
  NPD (past)

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1366811820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N FEDERAL HWY",
            "city": "POMPANO BEACH",
            "state": "FL",
            "postal_code": "330624319",
            "fax_number": "954-781-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CABOT DR STE 300",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605320916",
            "telephone_number": "954-781-7173",
            "fax_number": "630-210-8164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN TREATMENT CENTER IL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "SORY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-533-7705"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A-4152-0001-A",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D2101029",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aware Therapy LLC
• Fadel Fons Talasoun Azer, M.D.
• Anika Babu, CPT
• Back 2 Center PLLC
• Katherine F Baker, MD
• Violeta Barbolyuk
• Sue Ann Barrett, PHD, PMHNP
• Walter E Barron, RPH
• Bartlett Chiropractic Dba Doctors' Center for Integrative Wellness
• Marshall Kirk Basler, ATC

• Substance Abuse Rehabilitation Facility in Lisle, IL
• Providers in Lisle, IL by specialty
• Substance Abuse Rehabilitation Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.