Provider Demographics
NPI:1154868594
Name:DAMIAN FAMILY CARE CENTER, INC.
Entity type:Organization
Organization Name:DAMIAN FAMILY CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-657-1100
Mailing Address - Street 1:8956 162ND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5072
Mailing Address - Country:US
Mailing Address - Phone:718-657-1100
Mailing Address - Fax:718-657-1870
Practice Address - Street 1:11711 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1751
Practice Address - Country:US
Practice Address - Phone:718-847-9233
Practice Address - Fax:718-849-1093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAMIAN FAMILY CARE CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003246R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)