Damascus Road, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

300656AP Issued in CA

Legal business name

DAMASCUS ROAD, LLC

Practice address

1313 N Brookhurst St
Anaheim, CA 92801-1646

Phone

(559) 601-6065

NPI assigned

Aug 8, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Smith

Title

Office Coordinator

Phone

(559) 601-6065

Specialties & licenses 1

Addresses

Other names 1

• Bridges To Life Detox Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154875185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2496",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928370496",
            "telephone_number": "559-601-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 N BROOKHURST ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011646",
            "telephone_number": "559-601-6065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMASCUS ROAD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE COORDINATOR",
        "authorized_official_telephone_number": "559-601-6065"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300656AP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridges To Life Detox",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.