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Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Other names
Angel House
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE MARY LOPEZ MBA (PRESIDENT AND CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
1310 N SPEEDWAY PL, TUCSON, AZ 85715-5236
(520) 731-0635
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-2914
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305538
—
AZ
01
—
BH2914
ADHS/BRFL LICENSE
AZ
Enumeration date
01/28/2008
Last updated
10/09/2020
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