Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Other names
Nogales
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE LOPEZ MBA (CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
276 WEST VIEW POINT DRIVE, NOGALES, AZ 85621
(520) 281-0678
(520) 281-0772
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
OTC7773
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185236
—
AZ
01
—
OTC7773
ADHS/BMFL LICENSE
AZ
Enumeration date
09/02/2016
Last updated
10/09/2020
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