Provider Demographics
NPI:1841386224
Name:DAMON'S HOUSE INC.
Entity Type:Organization
Organization Name:DAMON'S HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LERRLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-245-2731
Mailing Address - Street 1:11900 E MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3357
Mailing Address - Country:US
Mailing Address - Phone:313-245-2731
Mailing Address - Fax:313-245-2734
Practice Address - Street 1:11900 E MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3357
Practice Address - Country:US
Practice Address - Phone:313-245-2731
Practice Address - Fax:313-245-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801009243104100000X
MI383016540251C00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No347C00000XTransportation ServicesPrivate Vehicle