Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Other names
Summit Residential
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSE LOPEZ MBA, CPA (PRESIDENT AND CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
2502 N DODGE BLVD STE 190A, TUCSON, AZ 85716-2671
(520) 618-8800
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
BH-4537
AZ
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH9011
STATE LICENSE
AZ
Enumeration date
06/03/2015
Last updated
12/19/2023
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