Healthcare Provider Details

I. General information

NPI: 1932466968
Provider Name (Legal Business Name): INTREPID U.S.A., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2694 LAKE PARK DR. FIRST FLOOR
NORTH CHARLESTON SC
29406-9826
US

IV. Provider business mailing address

4055 VALLEY VIEW LANE 5TH FLOOR
DALLAS TX
75244
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-2503
  • Fax:
Mailing address:
  • Phone: 214-445-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY PERRY
Title or Position: CEO
Credential:
Phone: 214-445-3750