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General NPI Number Information
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NPI Number | 1487104428
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Entity Type | Organization
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Legal Business Name | INTREPID OF PIEDMONT RIDGE, INC.
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 4005 ELECTRIC RD STE 200
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City | ROANOKE
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State | VA
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Zip | 24018-8435
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Country | US
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Telephone | 540-523-1160
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Fax | 540-265-2416
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Provider Business Mailing Address
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Address Line | 14841 DALLAS PKWY STE 625
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City | DALLAS
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State | TX
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Zip | 75254-7641
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Country | US
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Telephone | 214-445-3750
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Fax | 214-445-3950
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Authorized Official
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Title or Position | CCO
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Name | ROBERT PARKER
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Credential |
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Telephone | 214-445-3750
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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 | HSP 17230
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License Number State | VA
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