Provider Demographics
NPI:1619053345
Name:DAMASCUS HOUSE INC
Entity Type:Organization
Organization Name:DAMASCUS HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-789-7446
Mailing Address - Street 1:4203 RITCHIE HIGHWAY FRONT RESIDENTIAL
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 HIGHWAY
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:2006-10-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9802324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility