Healthcare Provider Details

I. General information

NPI: 1104768704
Provider Name (Legal Business Name): COURAGEOUS TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SW NOEL ST
LEES SUMMIT MO
64063-3810
US

IV. Provider business mailing address

1402 SW MARKET UNIT 592
LEES SUMMIT MO
64063-3810
US

V. Phone/Fax

Practice location:
  • Phone: 816-699-2352
  • Fax:
Mailing address:
  • Phone: 816-699-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MUSUDEEN HARRELL
Title or Position: TRUSTEE
Credential:
Phone: 816-699-2352