MEDICARE: COURAGE HEALTH SERVICES LLC

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1013509462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURAGE HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	8425 VALENCIA VILLAGE LN APT 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-6260
Country	:	US
Telephone Number	:	239-249-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	8425 VALENCIA VILLAGE LN APT 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-6260
Country	:	US
Telephone Number	:	239-249-2192
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VENIX COURAGEUX
Credential	:
Telephone Number	:	239-249-2192

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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