Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE M LOPEZ MBA (PRESIDENT AND CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
401 N BONITA AVE STE B, TUCSON, AZ 85745-2750
(520) 571-6466
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
—
146445
—
AZ
01
—
OTC9948
ADHS/BMFL LICENSE
AZ
Enumeration date
02/17/2016
Last updated
07/29/2024
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