Provider Demographics
NPI:1508955592
Name:DAMIAN FAMILY CARE CENTERS, INC.
Entity Type:Organization
Organization Name:DAMIAN FAMILY CARE CENTERS, INC.
Other - Org Name:PROJECT SAMARITAN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANACIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:718-657-1100
Mailing Address - Street 1:138-02 QUEENS BOULEVARD, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435
Mailing Address - Country:US
Mailing Address - Phone:718-657-1100
Mailing Address - Fax:718-657-1870
Practice Address - Street 1:137-50 JAMAICA AVENUE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435
Practice Address - Country:US
Practice Address - Phone:718-298-5100
Practice Address - Fax:718-298-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QE0700X
NY7003246R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01690633Medicaid
NY01690633Medicaid