Organization
INTERCOMMUNITY ACTION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BOLIN (EXECUTIVE DIRECTOR)
(215) 487-0906
Entity
Organization
Contact information
Practice address
2405 N 54TH ST, PHILADELPHIA, PA 19131-2423
(215) 477-6661
Mailing address
6012 RIDGE AVE, PHILADELPHIA, PA 19128-1643
(215) 487-0906
(215) 487-3716
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000008360047
—
PA
Enumeration date
04/24/2007
Last updated
08/22/2020
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