Healthcare Provider Details

I. General information

NPI: 1407958499
Provider Name (Legal Business Name): COURAGEOUS HOME HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 EISENHOWER PKWY BLDG B
MACON GA
31206-3159
US

IV. Provider business mailing address

4339 HARTLEY BRIDGE RD # 314
MACON GA
31216-5641
US

V. Phone/Fax

Practice location:
  • Phone: 478-477-7594
  • Fax: 478-477-2556
Mailing address:
  • Phone: 478-477-7594
  • Fax: 478-477-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number094-R-0003
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VALORIE D MARKHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 478-477-7594