Provider Demographics
NPI:1720680077
Name:CORBIN, SUDIA (ASSISTED LIVING)
Entity Type:Individual
Prefix:
First Name:SUDIA
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:ASSISTED LIVING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5405
Mailing Address - Country:US
Mailing Address - Phone:443-537-5246
Mailing Address - Fax:
Practice Address - Street 1:3835 SEQUOIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5405
Practice Address - Country:US
Practice Address - Phone:443-537-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility