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
6710 RIDGE AVE, PHILADELPHIA, PA 19128-2430
(215) 487-9591
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
01
—
1000008360063
PROMISE MAID
PA
Enumeration date
04/30/2007
Last updated
03/06/2008
Update your record
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