Healthcare Provider Details

I. General information

NPI: 1790041093
Provider Name (Legal Business Name): INTREPID OF VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 HOLLAND OFFICE PARK SUITE 503
VIRGINIA BEACH VA
23452-1140
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 625
DALLAS TX
75254-7641
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-0872
  • Fax: 757-490-0173
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