Provider Demographics
NPI:1073602611
Name:COURAGE REHAB CLINIC
Entity Type:Organization
Organization Name:COURAGE REHAB CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:EGUAE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:817-798-1991
Mailing Address - Street 1:PO BOX 151853
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015
Mailing Address - Country:US
Mailing Address - Phone:817-798-1991
Mailing Address - Fax:817-557-0772
Practice Address - Street 1:1670 NORTH HAMPTON ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-784-0385
Practice Address - Fax:817-557-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation