Healthcare Provider Details

I. General information

NPI: 1760318315
Provider Name (Legal Business Name): DAMIAN FAMILY CARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 AVENUE D
NEW YORK NY
10009-6935
US

IV. Provider business mailing address

8956 162ND ST FL 3
JAMAICA NY
11432-5072
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-0100
  • Fax: 718-866-0151
Mailing address:
  • Phone: 718-657-1100
  • Fax: 718-657-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KAVANAUGH CHANDLER
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 718-657-1100