Provider Demographics
NPI:1235674409
Name:START TREATMENT & RECOVERY CENTERS, INC.
Entity Type:Organization
Organization Name:START TREATMENT & RECOVERY CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DORIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-260-2933
Mailing Address - Street 1:937 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2347
Mailing Address - Country:US
Mailing Address - Phone:718-260-2900
Mailing Address - Fax:
Practice Address - Street 1:119 W 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4920
Practice Address - Country:US
Practice Address - Phone:718-260-2984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-27
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW04102Medicare UPIN
NYW04101Medicare UPIN