Organization
INTERMOUNTAIN HEALTH CENTER, INC.
Active
Organization
INTERMOUNTAIN HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROSE M. LOPEZ MBA (PRESIDENT AND CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
272 & 276 WEST VIEWPOINT DRIVE, NOGALES, AZ 85621
(520) 281-0678
(520) 281-0678
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
—
333689
—
AZ
01
—
OTC8493
ADHS/BMFL LICENSE
AZ
Enumeration date
10/24/2017
Last updated
10/11/2024
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