Provider Demographics
NPI:1639665912
Name:DAMOUS CENTER
Entity Type:Organization
Organization Name:DAMOUS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAMOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-720-3835
Mailing Address - Street 1:218 D ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-3104
Mailing Address - Country:US
Mailing Address - Phone:304-720-3835
Mailing Address - Fax:304-720-3836
Practice Address - Street 1:234 LEE AVE
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143
Practice Address - Country:US
Practice Address - Phone:304-201-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)