Healthcare Provider Details

I. General information

NPI: 1841386224
Provider Name (Legal Business Name): DAMON'S HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 E MCNICHOLS RD
DETROIT MI
48205-3357
US

IV. Provider business mailing address

11900 E MCNICHOLS RD
DETROIT MI
48205-3357
US

V. Phone/Fax

Practice location:
  • Phone: 313-245-2731
  • Fax: 313-245-2734
Mailing address:
  • Phone: 313-245-2731
  • Fax: 313-245-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number383016540
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number383016540
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801009243
License Number StateMI

VIII. Authorized Official

Name: DR. LERRLYN NELSON
Title or Position: FOUNDER
Credential: PH.D
Phone: 313-245-2731