Healthcare Provider Details

I. General information

NPI: 1528040169
Provider Name (Legal Business Name): INTREPID OF GOLDEN VALLEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 METRO BLVD SUITE 625
EDINA MN
55439-2303
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 952-513-5400
  • Fax: 952-513-5444
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 Number326853 CLASS A
License Number StateMN

VIII. Authorized Official

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