Provider Demographics
NPI:1578918751
Name:DAMASCUS HOUSE, INC.
Entity Type:Organization
Organization Name:DAMASCUS HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:BASKERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CSC-AD
Authorized Official - Phone:410-789-7446
Mailing Address - Street 1:4203 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2705
Mailing Address - Country:US
Mailing Address - Phone:410-789-7446
Mailing Address - Fax:410-789-1987
Practice Address - Street 1:4203 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-2705
Practice Address - Country:US
Practice Address - Phone:410-789-7446
Practice Address - Fax:410-789-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility