Healthcare Provider Details

I. General information

NPI: 1184012940
Provider Name (Legal Business Name): INTREPID OF THE APPALACHIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 LEE JACKSON HWY STE A3
STAUNTON VA
24401-9506
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 540-569-3431
  • Fax: 540-569-3433
Mailing address:
  • Phone: 214-445-3750
  • Fax: 214-445-3900

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