Provider Demographics
NPI:1134594906
Name:COURAGE LIVING CARE & SERVICES
Entity type:Organization
Organization Name:COURAGE LIVING CARE & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHEDETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:COURAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-910-5460
Mailing Address - Street 1:13020 SW 256TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13020 SW 256TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6925
Practice Address - Country:US
Practice Address - Phone:305-910-5460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111124GH385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0151263000Medicaid