| Intermountain Centers For Human Development Inc. | |
|
401 N Bonita Ave Ste B Tucson AZ 85745-2750 | |
| (520) 571-6466 | |
| Not Available |
| Full Name | Intermountain Centers For Human Development Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 401 N Bonita Ave Ste B, Tucson, Arizona |
| Authorized Official Name and Position | Rose M Lopez (PRESIDENT AND CEO) |
| Authorized Official Contact | 5207211887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain Centers For Human Development Inc. Po Box 86537 Tucson AZ 85754-6537 Ph: (520) 721-1887 | Intermountain Centers For Human Development Inc. 401 N Bonita Ave Ste B Tucson AZ 85745-2750 Ph: (520) 571-6466 |
| NPI Number | 1578922670 |
|---|---|
| Provider Enumeration Date | 02/17/2016 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578922670 | NPI | - | NPPES |
| OTC9948 | Other | AZ | ADHS/BMFL LICENSE |
| 146445 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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