Healthcare Provider Details

I. General information

NPI: 1982120911
Provider Name (Legal Business Name): INTERCOMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BUTTERNUT DR
EAST HARTFORD CT
06118-1906
US

IV. Provider business mailing address

111 FOUNDERS PLZ STE 1802
EAST HARTFORD CT
06108-8301
US

V. Phone/Fax

Practice location:
  • Phone: 860-569-5900
  • Fax:
Mailing address:
  • Phone: 860-569-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BEAUREGARD
Title or Position: CEO/PRESIDENT
Credential:
Phone: 860-569-5900