1285978338 NPI number — BANYAN SOBER LIVING, INC.

Table of content: DR. TINA MARIE MURPHY DC (NPI 1982730503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285978338 NPI number — BANYAN SOBER LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BANYAN SOBER LIVING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285978338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 E COMMERCIAL BLVD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-746-8232
Provider Business Mailing Address Fax Number:
954-746-8981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 E COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-746-8232
Provider Business Practice Location Address Fax Number:
954-746-8981
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ZAFFUTO
Authorized Official First Name:
NEISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
954-746-8232

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 10D2047989 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10D2047989 . This is a "CLIA CERTIFICATE OF WAIVER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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