Provider Demographics
NPI:1518187681
Name:DAMASCUS HOUSE INC.
Entity Type:Organization
Organization Name:DAMASCUS HOUSE INC.
Other - Org Name:DAMASCUS HOUSE COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-789-0080
Mailing Address - Street 1:4109 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2703
Mailing Address - Country:US
Mailing Address - Phone:410-789-0080
Mailing Address - Fax:410-789-0080
Practice Address - Street 1:4109 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2703
Practice Address - Country:US
Practice Address - Phone:410-789-0080
Practice Address - Fax:410-789-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903205251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health