Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Other names
Sells Outpatient
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
TOHONO PLAZA BLDG 4 STE 405 BIA STATE ROUTE 19, SELLS, AZ 85634
(520) 721-1887
(520) 407-5397
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508246
—
AZ
01
—
BH5148
TRIBAL MOU
AZ
Enumeration date
11/23/2009
Last updated
09/25/2024
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