{
"Npi": {
"NPI": "1295717874",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "INTREPID AFFILIATES INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6600 FRANCE AVENUE SOUTH",
"SecondLineMailingAddress": "SUITE 510",
"MailingAddressCityName": "EDINA",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55435-1804",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "952-285-7300",
"MailingAddressFaxNumber": "952-285-6827",
"FirstLinePracticeLocationAddress": "5445 SOUTH WYCK BLVD",
"SecondLinePracticeLocationAddress": "SUITE 208",
"PracticeLocationAddressCityName": "TOLEDO",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43614",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-861-2722",
"PracticeLocationAddressFaxNumber": "419-861-2725",
"EnumerationDate": "11/18/2005",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VONARX",
"AuthorizedOfficialFirstName": "GREG",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "CFO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "952-285-7300",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251E00000X",
"TaxonomyName": "Home Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}