NPIMap

Organization Active NPI

Damian Family Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • New York, NY
National Provider Identifier
1336650688
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7003246R Issued in NY
Legal business name
DAMIAN FAMILY CARE CENTERS, INC.
Practice address
13 Hell Gate Cir
New York, NY 10035-6602
Phone
(718) 657-1100
Fax
(718) 657-1870
NPI assigned
Oct 13, 2017
Last updated
Jun 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kavanaugh Chandler, MD
Title
President / Ceo
Phone
(718) 657-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7003246R NY Primary

Addresses

Primary practice location

13 Hell Gate Cir
New York, NY 10035-6602

Mailing address

8956 162ND St FL 3
Jamaica, NY 11432-5072
Phone (718) 657-1100

Other identifiers 1

IdentifierTypeStateIssuer
06059883MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180613000045 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507849882 Practice locations: New York, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336650688. Details of each certification follow.

Federally qualified health center certification: CCN 571114

Legal name
DAMIAN FAMILY CARE CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2018
Last certification
Jul 10, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1999 in NY
Enrollment address
13 Hell Gate Cir
New York, NY 10035-6602

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John Tavolacci Individual Corporate DirectorBoard Member Jun 21, 2016
Junnie E Campbell Individual Corporate DirectorBoard Secretary Jun 15, 2004
Arismendi Jimenez Individual Corporate DirectorBoard Member Mar 31, 2017
Michael Degraffenreid Individual Corporate DirectorBoard Member Jun 15, 2004
Cynthia Cortes Individual Corporate DirectorBoard Member Jun 15, 2004
Idania Lopez Mercado Individual Corporate Director Aug 16, 2016
Kavanaugh Chandler Individual Corporate OfficerCeo Apr 13, 2026
Corporate DirectorPresident Apr 13, 2026
W-2 Managing EmployeePresident / Ceo Apr 13, 2026
Chinyere Eze-Nliam Individual Corporate DirectorBoard Member Mar 29, 2016

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781136000000",
    "number": "1336650688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8956 162ND ST FL 3",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325072",
            "telephone_number": "718-657-1100",
            "fax_number": "718-657-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 HELL GATE CIR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100356602",
            "telephone_number": "718-657-1100",
            "fax_number": "718-657-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMIAN FAMILY CARE CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "KAVANAUGH",
        "authorized_official_title_or_position": "PRESIDENT  / CEO",
        "authorized_official_telephone_number": "718-657-1100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7003246R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06059883",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.