Organization
INTERMOUNTAIN HEALTH CENTER INC
Active
Parent organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT
Authorized official
ROSE MARY LOPEZ MBA (PRESIDENT AND CEO)
(520) 721-1887
Entity
Organization
Contact information
Practice address
5055 E BROADWAY BLVD STE C104, TUCSON, AZ 85711-3641
(520) 628-9833
(520) 623-9083
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
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198509
—
AZ
01
—
OTC7779
ADHS/BMFL LICENSE
AZ
Enumeration date
09/24/2015
Last updated
02/29/2024
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