Organization
INTERCOMMUNITY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY BEAUREGARD LCSW (PRESIDENT & CEO)
(860) 291-1340
Entity
Organization
Contact information
Practice address
281 MAIN ST, EAST HARTFORD, CT 06118-1823
(860) 569-5900
Mailing address
111 FOUNDERS PLZ, SUITE 1802, EAST HARTFORD, CT 06108-3212
(860) 569-5900
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
702
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008047966
—
CT
Enumeration date
03/23/2015
Last updated
06/08/2016
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