MEDICARE: COURAGE TO COMMIT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	045002105	CA

General Provider Information

NPI Number	:	1053560839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURAGE TO COMMIT, INC.

Provider Business Mailing Address
First Line	:	1310 ESPLANADE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-3331
Country	:	US
Telephone Number	:	530-345-6674
Fax Number	:	530-345-6675

Provider Business Practice Location Address
First Line	:	1310 ESPLANADE
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-3331
Country	:	US
Telephone Number	:	530-345-6674
Fax Number	:	530-345-6675

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CATHY LEE MCHARGUE
Credential	:
Telephone Number	:	530-345-6674

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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