Provider Demographics
NPI:1407958499
Name:COURAGEOUS HOME HEALTHCARE INC.
Entity Type:Organization
Organization Name:COURAGEOUS HOME HEALTHCARE INC.
Other - Org Name:COURAGEOUS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALORIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-477-7594
Mailing Address - Street 1:4339 HARTLEY BRIDGE RD # 314
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5641
Mailing Address - Country:US
Mailing Address - Phone:478-477-7594
Mailing Address - Fax:478-477-2556
Practice Address - Street 1:1667 EISENHOWER PKWY BLDG B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3159
Practice Address - Country:US
Practice Address - Phone:478-477-7594
Practice Address - Fax:478-477-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
GA094-R-0003372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA254965700AMedicaid
GA277797004BMedicaid
GA277797004CMedicaid
GA277797004EMedicaid