Healthcare Provider Details

I. General information

NPI: 1073595625
Provider Name (Legal Business Name): INTREPID OF THE OZARKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 KIMBERLY ST.
MCCRORY AR
72101-0365
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-5441
  • Fax: 870-731-2613
Mailing address:
  • Phone: 214-445-3750
  • Fax: 214-445-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR4685
License Number StateAR

VIII. Authorized Official

Name: ROBERT PARKER
Title or Position: CCO
Credential:
Phone: 214-445-3750