Healthcare Provider Details

I. General information

NPI: 1457843336
Provider Name (Legal Business Name): CORBIN'S CLUBHOUSE AUTISM & SPECIAL NEEDS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MILFORD ST
CLARKSBURG WV
26301-3517
US

IV. Provider business mailing address

PO BOX 1222
CLARKSBURG WV
26302-1222
US

V. Phone/Fax

Practice location:
  • Phone: 304-629-6706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BILLEE JEAN BELL
Title or Position: CARE TAKER
Credential:
Phone: 304-629-6706