Provider Demographics
NPI:1578026183
Name:INTREPID HOME CARE OF OKLAHOMA
Entity Type:Organization
Organization Name:INTREPID HOME CARE OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-920-5038
Mailing Address - Street 1:500 W 15TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3640
Mailing Address - Country:US
Mailing Address - Phone:405-920-5038
Mailing Address - Fax:
Practice Address - Street 1:500 W 15TH ST STE 3
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3640
Practice Address - Country:US
Practice Address - Phone:405-920-5038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health