# INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Angel House
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417134933
- **Authorized official:** ROSE MARY LOPEZ MBA (PRESIDENT AND CEO)
- **Authorized official phone:** (520) 721-1887

## Contact information

- **Practice address:** 1310 N SPEEDWAY PL, TUCSON, AZ 85715-5236
- **Practice address phone:** (520) 731-0635
- **Mailing address:** PO BOX 86537, TUCSON, AZ 85754-6537
- **Mailing address phone:** (520) 721-1887
- **Mailing address fax:** (520) 721-0069

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-2914 | AZ | Yes |

## Other

- **Enumeration date:** 01/28/2008
- **Last updated:** 10/09/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 305538 | — | AZ |
| 01 | — | BH2914 | ADHS/BRFL LICENSE | AZ |