Organization
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT
Active
Other names
Intermountain Centers
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
401 N BONITA AVE, TUCSON, AZ 85709-5001
(520) 571-6466
(520) 721-0069
Mailing address
PO BOX 86537, TUCSON, AZ 85754-6537
(520) 721-1887
(520) 721-0069
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146445
—
AZ
01
—
OTC9948
ADHS/BMFL LICENSE
AZ
Enumeration date
09/18/2019
Last updated
04/29/2020
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