NPIMap

Organization Active NPI

Damian Family Care Centers, Inc.

Doing business as Project Samaritan Health Services

  • Federally Qualified Health Center (FQHC)
  • Long Island City, NY
National Provider Identifier
1619415288
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.
Doing business as
Project Samaritan Health Services
Practice address
3411 Vernon Blvd
Long Island City, NY 11106-5121
Phone
(212) 595-5810
Fax
(718) 657-1870
NPI assigned
Feb 3, 2017
Last updated
Jun 11, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
DAMIAN FAMILY CARE CENTERS, INC.As reported in NPPES

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

3411 Vernon Blvd
Long Island City, NY 11106-5121

Mailing address

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

Other names 1

  • Project Samaritan Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180613001502 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507849882 Practice locations: Long Island City, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619415288. Details of each certification follow.

Federally qualified health center certification: CCN 571117

Legal name
DAMIAN FAMILY CARE CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2018
Last certification
Jun 19, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1999 in NY
Enrollment address
3411 Vernon Blvd
Long Island City, NY 11106-5121

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
Part of
Damian Family Care Centers Inc

Ownership & related parties

All disclosed owners & managing parties 12

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
Peter Grisafi Individual Corporate OfficerCeo Oct 1, 2013
Corporate DirectorPresident Oct 1, 2013
W-2 Managing EmployeePresident/ Ceo Oct 1, 2013
Junnie E Campbell Individual Corporate DirectorChair Jun 15, 2004
Arismendi Jimenez Individual Corporate DirectorBoard Member Mar 21, 2017
Michael Degraffenreid Individual Corporate DirectorBoard Member Jun 15, 2004
Cynthia Cortes Individual Corporate DirectorBoard Member Jun 15, 2004
Janet Moss Individual Corporate DirectorBoard Member Sep 1, 2010
Idania Lopez Mercado Individual Corporate DirectorBoard Member Aug 16, 2016
Evdoxia Pittas Individual Corporate DirectorBoard Member Mar 21, 2017
Kavanaugh Chandler Individual Corporate OfficerCeo Apr 13, 2026
Corporate DirectorPresident Apr 13, 2026
W-2 Managing EmployeePresident/Ceo Apr 13, 2026
Jane Velez Individual Corporate DirectorBoard Vice Chair Jun 15, 2004
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": "1486080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781136000000",
    "number": "1619415288",
    "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": "3411 VERNON BLVD",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111065121",
            "telephone_number": "212-595-5810",
            "fax_number": "718-657-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMIAN FAMILY CARE CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAMIAN FAMILY CARE CENTERS, INC.",
        "enumeration_date": "2017-02-03",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Project Samaritan Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Island City, NY

Sources for this page

Verify at the official NPI Registry.