Provider Demographics
NPI:1992758361
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 EXECUTIVE 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 1:2191 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3520
Practice Address - Country:US
Practice Address - Phone:212-348-5650
Practice Address - Fax:212-987-3023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:START TREATMENT & RECOVERY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001214R261Q00000X
NY060510355261QM2800X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244606Medicaid
NY00244606Medicaid