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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