Organization Name: | INTERCOMMUNITY, INC. |
NPI Number: | 1073548533 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIMBERLY L BEAUREGARD (CEO & PRESIDENT) |
Mailing Address: | 281 Main Street East Hartford |
State: | CT US |
Postal Code: | 061181883 |
Phone Number: | 8605695900 |
Fax Number: | 8605695614 |
NPI Enumeration Date: | 07/12/2006 |
NPI Last Update Date: | 03/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | C0178 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |