Provider Demographics
NPI:1164580379
Name:INTERCOMMUNITY, INC.
Entity Type:Organization
Organization Name:INTERCOMMUNITY, INC.
Other - Org Name:INTERCOMMUNITY RECOVERY CENTERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-291-1340
Mailing Address - Street 1:111 FOUNDERS PLAZA
Mailing Address - Street 2:SUITE 1802
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-714-3701
Mailing Address - Fax:860-714-8974
Practice Address - Street 1:16 COVENTRY STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-714-3701
Practice Address - Fax:860-714-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTSA-0159261QM0850X
CTSA-0201324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA000422OtherSAGA
CT004134730Medicaid
CT004042065Medicaid
CTCTGA000422OtherSAGA