Provider Demographics
NPI:1740581693
Name:CORUM HUMAN SERVICES, LLC
Entity Type:Organization
Organization Name:CORUM HUMAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORUM-KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-336-0565
Mailing Address - Street 1:211 FARMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-7648
Mailing Address - Country:US
Mailing Address - Phone:540-336-0565
Mailing Address - Fax:
Practice Address - Street 1:433 LILYS WAY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-7686
Practice Address - Country:US
Practice Address - Phone:540-542-1807
Practice Address - Fax:540-542-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities