Provider Demographics
NPI:1386895985
Name:START TREATMENT & RECOVERY CENTERS INC
Entity type:Organization
Organization Name:START TREATMENT & RECOVERY CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL 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 FL 6
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:917-386-1790
Practice Address - Fax:212-865-2485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:START TREATMENT & RECOVERY CENTERS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100811572251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244606Medicaid
NYW04102Medicare PIN