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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