Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Active
Other names
Kiva 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
3626 E LEE ST BLDG 1, TUCSON, AZ 85716-3717
(520) 319-5477
(520) 319-5491
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
Primary
BH-1012
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199176
—
AZ
01
—
BH1012
STATE LICENSE
AZ
Enumeration date
10/11/2006
Last updated
10/09/2020
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