| Intercommunity, Inc. | |
|
16 Coventry Street Hartford CT 06112 | |
| (860) 714-3701 | |
| (860) 714-8974 |
| Full Name | Intercommunity, Inc. |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 16 Coventry Street, Hartford, Connecticut |
| Authorized Official Name and Position | Kimberly L Beauregard (PRESIDENT & CEO) |
| Authorized Official Contact | 8602911340 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intercommunity, Inc. 111 Founders Plaza Suite 1802 East Hartford CT 06108 Ph: (860) 714-3701 | Intercommunity, Inc. 16 Coventry Street Hartford CT 06112 Ph: (860) 714-3701 |
| NPI Number | 1164580379 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164580379 | NPI | - | NPPES |
| CTGA000422 | Other | CT | SAGA |
| 004134730 | Medicaid | CT | |
| 004042065 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | SA-0159 (Connecticut) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | SA-0201 (Connecticut) | Primary |
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