Provider Demographics
NPI:1659673663
Name:DAMASCUS ROAD
Entity Type:Organization
Organization Name:DAMASCUS ROAD
Other - Org Name:HOUSE OF HEALING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERICK
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-207-9911
Mailing Address - Street 1:1839 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5005
Mailing Address - Country:US
Mailing Address - Phone:718-207-9911
Mailing Address - Fax:718-485-1873
Practice Address - Street 1:1057 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5116
Practice Address - Country:US
Practice Address - Phone:718-207-9911
Practice Address - Fax:718-485-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty