Banyan Gulf Breeze LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

BANYAN GULF BREEZE LLC

Practice address

1830 Hickory Shores Rd
Gulf Breeze, FL 32563-9143

Phone

(754) 206-8522

Fax

(850) 677-0312

NPI assigned

Jul 3, 2023

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 3

Addresses

Other identifiers 1

Tax ID family

Banyan Gulf Breeze LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Banyan Gulf Breeze LLC

  • Substance Abuse Rehabilitation Facility
  • Gulf Breeze, FL
  • NPI 1033899372
  NPD tax ID

Locations

Practitioners 1

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.

• Eric E Goldberg, DO

  • Psychiatry Physician
  • Destin, FL
  • NPI 1679524946
  NPD (past)

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

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1386321180",
    "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",
            "telephone_number": "954-533-7705",
            "fax_number": "954-781-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 HICKORY SHORES RD",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325639143",
            "telephone_number": "754-206-8522",
            "fax_number": "850-677-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANYAN GULF BREEZE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-03",
        "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": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122549700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randall Scott Bailey Sr., D.M.D.
• Lola Baker, LMT
• Balance Behavioral Health, LLC
• Randy Gene Banks, PA-C
• Banyan Gulf Breeze LLC
• Baptist Health Care, Inc
• Baptist Health Care, Inc. (Gulf Breeze Hospital)
• Baptist Hospital, Inc. (Baptist Home Health Care Medical Equipment and Supplies)
• Baptist Medical Group LLC
• Baptist Medical Group LLC

• Substance Abuse Rehabilitation Facility in Gulf Breeze, FL
• Providers in Gulf Breeze, FL by specialty
• Substance Abuse Rehabilitation Facility in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.