Healthcare Provider Details

I. General information

NPI: 1295717841
Provider Name (Legal Business Name): INTREPID OF IOWA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 WALNUT ST FL 4
DES MOINES IA
50309-3929
US

IV. Provider business mailing address

3220 KELLER SPRINGS RD STE 108
CARROLLTON TX
75006-5911
US

V. Phone/Fax

Practice location:
  • Phone: 515-278-9920
  • Fax: 515-278-9639
Mailing address:
  • Phone: 214-445-3750
  • Fax: 214-445-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN M KUNYSZ JR.
Title or Position: CEO
Credential:
Phone: 214-445-3750