Healthcare Provider Details

I. General information

NPI: 1033541818
Provider Name (Legal Business Name): INTERCOMMUNITY ACTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 STENTON AVE
PHILADELPHIA PA
19138-1625
US

IV. Provider business mailing address

6012 RIDGE AVE
PHILADELPHIA PA
19128-1643
US

V. Phone/Fax

Practice location:
  • Phone: 215-487-1320
  • Fax:
Mailing address:
  • Phone: 215-487-0906
  • Fax: 215-487-3716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID BOLIN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 215-487-0906