Provider Demographics
NPI:1346581154
Name:INTREPID U.S.A., INC
Entity Type:Organization
Organization Name:INTREPID U.S.A., INC
Other - Org Name:INTREPID USA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-445-3750
Mailing Address - Street 1:4055 VALLEY VIEW LN FL 5
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5074
Mailing Address - Country:US
Mailing Address - Phone:214-442-0920
Mailing Address - Fax:
Practice Address - Street 1:679 W ELM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3585
Practice Address - Country:US
Practice Address - Phone:417-532-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based