Healthcare Provider Details

I. General information

NPI: 1306828983
Provider Name (Legal Business Name): INTREPID OF NEW YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EAST AVE UNIT #101 ROCHESTER CLUB CENTRE
ROCHESTER NY
14604-2551
US

IV. Provider business mailing address

6600 FRANCE AVE S SUITE 510
EDINA MN
55435-1804
US

V. Phone/Fax

Practice location:
  • Phone: 585-427-9900
  • Fax: 585-427-2414
Mailing address:
  • Phone: 952-285-7300
  • Fax: 952-285-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0965L001
License Number StateNY

VIII. Authorized Official

Name: MR. GREG A VON ARX
Title or Position: CFO
Credential:
Phone: 952-285-7300