MEDICARE: INTREPID OF WASHINGTON INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	346	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124000708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTREPID OF WASHINGTON INC

Provider Business Mailing Address
First Line	:	14841 DALLAS PKWY STE 625
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-7641
Country	:	US
Telephone Number	:	214-445-3750
Fax Number	:	214-445-3902

Provider Business Practice Location Address
First Line	:	9715 N NEVADA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3412
Country	:	US
Telephone Number	:	509-466-0954
Fax Number	:	509-466-9325

Authorized Official
Title or Position	:	CCO
Name	:	ROBERT PARKER
Credential	:
Telephone Number	:	214-445-3750

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/08/2022

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