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General NPI Number Information
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NPI Number | 1346629995
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Entity Type | Organization
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Legal Business Name | DAMIAN FAMILY CARE CENTERS, INC.
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 216 FOX HOLLOW ROAD
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City | RHINEBECK
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State | NY
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Zip | 12572
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Country | US
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Telephone | 845-516-1002
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Fax | 845-876-5173
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Provider Business Mailing Address
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Address Line | 138-02 QUEENS BOULEVARD, 2ND FLOOR
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City | BRIARWOOD
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State | NY
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Zip | 11435
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Country | US
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Telephone | 718-657-1100
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Fax | 718-657-1870
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JOHN CHUE
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Credential | CPA
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Telephone | 718-657-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 7003246R
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State | NY
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