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General NPI Number Information
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NPI Number | 1710960968
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Entity Type | Organization
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Legal Business Name | INTREPID OF NORTH CAROLINA INC
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 343 E SIX FORKS RD SUITE 100
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City | RALEIGH
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State | NC
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Zip | 27609-7800
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Country | US
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Telephone | 800-420-0081
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Fax | 919-855-9981
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Provider Business Mailing Address
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Address Line | 4055 VALLEY VIEW LN 5TH FLOOR
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City | DALLAS
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State | TX
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Zip | 75244-5074
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Country | US
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Telephone | 214-445-3750
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Fax | 214-445-3902
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Authorized Official
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Title or Position | CEO
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Name | MR. WESLEY PERRY
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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 | HC1137
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License Number State | NC
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