Provider Demographics
NPI:1851572036
Name:DAMON'S FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:DAMON'S FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCHESTER
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:336-771-8602
Mailing Address - Street 1:1749 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-1509
Mailing Address - Country:US
Mailing Address - Phone:336-771-8602
Mailing Address - Fax:336-771-8603
Practice Address - Street 1:1749 BUTLER ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1509
Practice Address - Country:US
Practice Address - Phone:336-771-8602
Practice Address - Fax:336-771-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health