Provider Demographics
NPI:1124117148
Name:INTRUST HEALTH CARE
Entity type:Organization
Organization Name:INTRUST HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADLER
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-219-9773
Mailing Address - Street 1:19050 FULLER HEIGHTS RD
Mailing Address - Street 2:APT 312
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-2100
Mailing Address - Country:US
Mailing Address - Phone:850-345-8724
Mailing Address - Fax:
Practice Address - Street 1:19050 FULLER HEIGHTS RD
Practice Address - Street 2:APT 312
Practice Address - City:TRIANGLE
Practice Address - State:VA
Practice Address - Zip Code:22172-2100
Practice Address - Country:US
Practice Address - Phone:850-345-8724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06L21742332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies