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General NPI Number Information
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NPI Number | 1184004814
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Entity Type | Organization
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Legal Business Name | INTREPID HOLDINGS INC
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 3207 SKYLANE DR SUITE 110
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City | CARROLLTON
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State | TX
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Zip | 75006-2559
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Country | US
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Telephone | 469-440-8887
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Fax |
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Provider Business Mailing Address
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Address Line | 3207 SKYLANE DR SUITE 110
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City | CARROLLTON
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State | TX
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Zip | 75006-2559
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Country | US
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Telephone | 469-440-8887
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. SANTHI S KUMAR
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Credential |
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Telephone | 214-226-8164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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