Provider Demographics
NPI:1912368176
Name:COURAGE TO CHANGE, INC.
Entity Type:Organization
Organization Name:COURAGE TO CHANGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-594-4855
Mailing Address - Street 1:252 HIGH SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-9502
Mailing Address - Country:US
Mailing Address - Phone:559-594-4855
Mailing Address - Fax:559-594-0086
Practice Address - Street 1:1230 N ANDERSON RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-9674
Practice Address - Country:US
Practice Address - Phone:559-594-4855
Practice Address - Fax:559-594-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200700253J00000X
CA540014BN3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children