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General NPI Number Information
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NPI Number | 1659353233
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Entity Type | Organization
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Legal Business Name | INTREPID OF THE TWIN CITIES INC
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 3433 BROADWAY ST NE STE 240A
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1740
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Country | US
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Telephone | 651-638-7800
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Fax | 651-638-7801
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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 | 214-445-3900
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JOHN KUNYSZ JR.
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 325703
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License Number State | MN
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