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General NPI Number Information
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NPI Number | 1518136829
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Entity Type | Organization
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Legal Business Name | INTERCOMMUNITY ACTION, INC.
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 6012 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128
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Country | US
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Telephone | 215-487-0906
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Fax | 215-487-3716
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Provider Business Mailing Address
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Address Line | 6012 RIDGE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1643
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Country | US
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Telephone | 610-389-9149
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Fax | 215-487-3716
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Authorized Official
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Title or Position | IT CONSULTANT
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Name | SHRONDA PETERSON
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Credential |
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Telephone | 610-389-9149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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