Healthcare Provider Details

I. General information

NPI: 1548174774
Provider Name (Legal Business Name): CORBIN HOUSE SOBER LIVING FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 CORBIN LN
LODI CA
95242-3628
US

IV. Provider business mailing address

2448 CORBIN LN
LODI CA
95242-3628
US

V. Phone/Fax

Practice location:
  • Phone: 209-649-7510
  • Fax:
Mailing address:
  • Phone: 209-649-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURANCE BERTALINO
Title or Position: PRESIDENT
Credential:
Phone: 209-649-7510