Provider Demographics
NPI:1669932562
Name:DAMASCUS HOUSE FOUNDATION
Entity type:Organization
Organization Name:DAMASCUS HOUSE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LGPC
Authorized Official - Phone:240-338-2534
Mailing Address - Street 1:4405 LARGO RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7837
Mailing Address - Country:US
Mailing Address - Phone:240-338-2534
Mailing Address - Fax:
Practice Address - Street 1:4405 LARGO RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-7837
Practice Address - Country:US
Practice Address - Phone:240-338-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit