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Provider Demographic Information - INTERCOMMUNITY ACTION INC

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PROVIDER DEMOGRAPHIC INFORMATION Supporting line for group header


Name:	INTERCOMMUNITY ACTION INC
Address:	403 RECTOR ST PHILADELPHIA, PA 19128-3522
Phone:	(215) 487-0904
E-mail:	LKUBICKY@INTERCOMMUNITYACTION.ORG
Web Site:	N/A

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PROVIDER CERTIFICATION INFORMATION Supporting line for group header

Click here to view Provider Certification Information

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PROVIDER'S PARENT/ REGIONAL OFFICE Supporting line for group header


Type:	Corporate Office
Name:	INTERCOMMUNITY ACTION, INC.
Address:	403 Rector Street PHILADELPHIA, PA 19128-1643
Phone:	(215) 487-0904
Fax:	(215) 487-3716


Type:	Regional/Field Office	Counties Served:	Philadelphia
Name:	INTERCOMMUNITY ACTION, INC
Address:	403 Rector Street PHILADELPHIA, PA 19128-1643
Phone:	(215) 487-0904
Fax:	(215) 508-6714


Type:	Regional/Field Office	Counties Served:
Name:	INTERCOMMUNITY ACTION, INC
Address:	403 Rector Street PHILADELPHIA, PA 19128-1643
Phone:	(215) 487-0904
Fax:	(215) 487-3716

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PROVIDER SERVICES AND RATES Supporting line for group header


County : Montgomery
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-5-8 Person-NG 1-Elig	$283.18 / 1 Day
Res Hab-5-8 Person-NG 1-Elig-w/Day Supports	$224.75 / 1 Day
Res Hab-5-8 Person-NG 2-Elig	$330.71 / 1 Day
Res Hab-5-8 Person-NG 2-Elig-w/Day Supports	$265.75 / 1 Day
Res Hab-5-8 Person-NG 3-Elig	$381.85 / 1 Day
Res Hab-5-8 Person-NG 3-Elig-w/Day Supports	$333.29 / 1 Day
Res Hab-5-8 Person-NG 4-Elig	$454.78 / 1 Day
Res Hab-5-8 Person-NG 4-Elig-w/Day Supports	$358.89 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-5-8 Person-Inelig	$22.87 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.

County : Philadelphia
\|Service Name / Level	\|Rate

Res Hab-1 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-1 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-1 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-1 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-1 Person-NG 3-Elig	$980.38 / 1 Day
Res Hab-1 Person-NG 3-Elig-w/Day Supports	$790.99 / 1 Day
Res Hab-1 Person-NG 4-Elig	$1,185.86 / 1 Day
Res Hab-1 Person-NG 4-Elig-w/Day Supports	$871.56 / 1 Day
Res Hab-1 Person-NG5-Elig	$1,754.51 / 1 Day
Res Hab-1 Person-NG5-Elig-w/Day Supports	$1,341.85 / 1 Day
Res Hab-2 Person-NG 1-Elig	$554.38 / 1 Day
Res Hab-2 Person-NG 1-Elig-w/Day Supports	$433.05 / 1 Day
Res Hab-2 Person-NG 2-Elig	$643.34 / 1 Day
Res Hab-2 Person-NG 2-Elig-w/Day Supports	$545.91 / 1 Day
Res Hab-2 Person-NG 3-Elig	$726.82 / 1 Day
Res Hab-2 Person-NG 3-Elig-w/Day Supports	$668.54 / 1 Day
Res Hab-2 Person-NG 4-Elig	$869.36 / 1 Day
Res Hab-2 Person-NG 4-Elig-w/Day Supports	$730.86 / 1 Day
Res Hab-2 Person-NG5-Elig	$1,312.57 / 1 Day
Res Hab-2 Person-NG5-Elig-w/Day Supports	$1,215.16 / 1 Day
Res Hab-3 Person-NG 1-Elig	$411.03 / 1 Day
Res Hab-3 Person-NG 1-Elig-ECS	$492.48 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports	$312.16 / 1 Day
Res Hab-3 Person-NG 1-Elig-w/Day Supports-ECS	$369.79 / 1 Day
Res Hab-3 Person-NG 2-Elig	$468.38 / 1 Day
Res Hab-3 Person-NG 2-Elig-ECS	$569.76 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports	$361.68 / 1 Day
Res Hab-3 Person-NG 2-Elig-w/Day Supports-ECS	$431.80 / 1 Day
Res Hab-3 Person-NG 3-Elig	$545.05 / 1 Day
Res Hab-3 Person-NG 3-Elig-ECS	$662.25 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports	$467.35 / 1 Day
Res Hab-3 Person-NG 3-Elig-w/Day Supports-ECS	$565.43 / 1 Day
Res Hab-3 Person-NG 4-Elig	$662.22 / 1 Day
Res Hab-3 Person-NG 4-Elig-ECS	$810.18 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports	$513.07 / 1 Day
Res Hab-3 Person-NG 4-Elig-w/Day Supports-ECS	$623.58 / 1 Day
Res Hab-3 Person-NG5-Elig	$1,004.32 / 1 Day
Res Hab-3 Person-NG5-Elig-w/Day Supports	$835.46 / 1 Day
Res Hab-4 Person-NG 1-Elig-w/Day Supports	$245.99 / 1 Day
Res Hab-4 Person-NG 2-Elig-w/Day Supports	$284.31 / 1 Day
Res Hab-4 Person-NG 3-Elig-w/Day Supports	$362.42 / 1 Day
Res Hab-4 Person-NG 4-Elig-w/Day Supports	$398.69 / 1 Day
Res Hab-4 Person-NG5-Elig-w/Day Supports	$642.84 / 1 Day
Res Hab-5-8 Person-NG 1-Elig	$283.18 / 1 Day
Res Hab-5-8 Person-NG 1-Elig-w/Day Supports	$224.75 / 1 Day
Res Hab-5-8 Person-NG 2-Elig	$330.71 / 1 Day
Res Hab-5-8 Person-NG 2-Elig-w/Day Supports	$265.75 / 1 Day
Res Hab-5-8 Person-NG 3-Elig	$381.85 / 1 Day
Res Hab-5-8 Person-NG 3-Elig-w/Day Supports	$333.29 / 1 Day
Res Hab-5-8 Person-NG 4-Elig	$454.78 / 1 Day
Res Hab-5-8 Person-NG 4-Elig-w/Day Supports	$358.89 / 1 Day
Res Hab-5-8 Person-NG5-Elig	$683.54 / 1 Day
Res Hab-5-8 Person-NG5-Elig-w/Day Supports	$579.75 / 1 Day
Res Hab-Lic-1 Person-Inelig	$105.05 / 1 Day
Res Hab-Lic-2 Person-Inelig	$57.29 / 1 Day
Res Hab-Lic-3 Person-Inelig	$41.06 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 1	$322.49 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 2	$367.82 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 3	$425.56 / 1 Day
Res Hab-Lic-4 Person-Elig-NG 4	$510.56 / 1 Day
Res Hab-Lic-4 Person-Elig-NG5	$766.28 / 1 Day
Res Hab-Lic-4 Person-Inelig	$31.91 / 1 Day
Res Hab-Lic-5-8 Person-Inelig	$22.87 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Eligible)	$140.44 / 1 Day
Resid Hab-Unlic 1-Indiv Home (Inelig)	$28.29 / 1 Day
Supplemental Habilitation 1:1 - 15 min	$6.12 / 15 min.
Supplemental Habilitation 2:1 - 15 min	$12.22 / 15 min.

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