Provider Demographics
NPI:1669542817
Name:CORBIN HOUSE, INC.
Entity type:Organization
Organization Name:CORBIN HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:HINES
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-749-0900
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:BETHANIA
Mailing Address - State:NC
Mailing Address - Zip Code:27010-0107
Mailing Address - Country:US
Mailing Address - Phone:336-771-3122
Mailing Address - Fax:
Practice Address - Street 1:400 CORBIN ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1960
Practice Address - Country:US
Practice Address - Phone:336-771-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL034187320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603943Medicaid