| Courageous Aim Llc | |
|
2805 Eastern Ave Ste D Davenport IA 52803-2074 | |
| (563) 505-0141 | |
| Not Available |
| Full Name | Courageous Aim Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2805 Eastern Ave Ste D, Davenport, Iowa |
| Authorized Official Name and Position | Laura Marie Carothers (OWNER/PROVIDER) |
| Authorized Official Contact | 5635050141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Courageous Aim Llc 2805 Eastern Ave Ste D Davenport IA 52803-2074 Ph: (563) 505-0141 | Courageous Aim Llc 2805 Eastern Ave Ste D Davenport IA 52803-2074 Ph: (563) 505-0141 |
| NPI Number | 1003538612 |
|---|---|
| Provider Enumeration Date | 09/12/2022 |
| Last Update Date | 09/28/2022 |
| Certification Date | 09/28/2022 |
| Medicare PECOS PAC ID | 0749658144 |
|---|---|
| Medicare Enrollment ID | O20221116000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003538612 | NPI | - | NPPES |
| 0074526 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Laura M Carothers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497910608 PECOS PAC ID: 3173649985 Enrollment ID: I20100929001502 |
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