Provider Demographics
NPI:1700209095
Name:INTERCOMMUNITY ACTION, INC.
Entity Type:Organization
Organization Name:INTERCOMMUNITY ACTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-487-0906
Mailing Address - Street 1:6012 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1643
Mailing Address - Country:US
Mailing Address - Phone:215-487-0906
Mailing Address - Fax:215-487-3716
Practice Address - Street 1:67 E BRINGHURST ST
Practice Address - Street 2:JOHN WISTER ELEMENTARY SCHOOL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2338
Practice Address - Country:US
Practice Address - Phone:215-951-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health