Healthcare Provider Details

I. General information

NPI: 1659353233
Provider Name (Legal Business Name): INTREPID OF THE TWIN CITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 BROADWAY ST NE STE 240A
MINNEAPOLIS MN
55413-1740
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 651-638-7800
  • Fax: 651-638-7801
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 Number325703
License Number StateMN

VIII. Authorized Official

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