| Organization Name: | INTERCOMMUNITY MENTAL HEALTH GROUP |
| NPI Number: | 1245430891 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARSHALL GAINES (VICE PRESIDENT OF ADMINISTRATION) |
| Mailing Address: | 505 Silas Deane Hwy Wethersfield |
| State: | CT US |
| Postal Code: | 061092216 |
| Phone Number: | 8605695900 |
| Fax Number: | |
| NPI Enumeration Date: | 07/23/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | C-0109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |