Healthcare Provider Details

I. General information

NPI: 1891105110
Provider Name (Legal Business Name): INTREPID OF THE ROLLING HILLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 CLOVERLEAF SQ STE 1
BIG STONE GAP VA
24219-2752
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-1770
  • Fax: 276-523-1967
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: ROBERT PARKER
Title or Position: CCO
Credential:
Phone: 214-445-3750