Provider Demographics
NPI:1740720697
Name:SUPPORT BY DESIGN
Entity type:Organization
Organization Name:SUPPORT BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-927-7856
Mailing Address - Street 1:722 DULANEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5109
Mailing Address - Country:US
Mailing Address - Phone:443-927-7856
Mailing Address - Fax:
Practice Address - Street 1:3013 MONTEBELLO TER
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3311
Practice Address - Country:US
Practice Address - Phone:443-927-7856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health