Provider Demographics
NPI:1457843336
Name:CORBIN'S CLUBHOUSE AUTISM & SPECIAL NEEDS CORPORATION
Entity Type:Organization
Organization Name:CORBIN'S CLUBHOUSE AUTISM & SPECIAL NEEDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE TAKER
Authorized Official - Prefix:
Authorized Official - First Name:BILLEE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-629-6706
Mailing Address - Street 1:PO BOX 1222
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26302-1222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 MILFORD ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-3517
Practice Address - Country:US
Practice Address - Phone:304-629-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child