45D1005559 CLIA NUMBER - INTREPID OF WEST TEXAS INC DBA INTREPID USA HEALTHCARE SERVICES

Laboratory Demographics

CLIA Number: 45D1005559

Facility Name: INTREPID OF WEST TEXAS INC DBA INTREPID USA HEALTHCARE SERVICES

Facility Address:
3310 WEST LOOP 306
SAN ANGELO, TX
ZIP 76904
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Facility Phone Number: 325 658-5550

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1104808781

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	45D1005559
LAB Type	Home Health Agency
Facility Name	INTREPID OF WEST TEXAS INC DBA INTREPID USA HEALTHCARE SERVICES
Street	3310 WEST LOOP 306
City	SAN ANGELO
State	TX
ZIP	76904
Phone	325 658-5550
CertificateType	4
CertificateEffectiveDate	10/24/2022
CertificateExpirationDate	10/23/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024