NPIMap

Organization Active NPI

Intermountain Centers for Human Development Inc.

  • Community/Behavioral Health Agency
  • Tucson, AZ
National Provider Identifier
1083846661
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
BH3355 Issued in AZ
Legal business name
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Practice address
994 S Harrison Rd
Tucson, AZ 85748-6608
Phone
(520) 721-1887
Fax
(520) 721-0069
NPI assigned
Aug 17, 2009
Last updated
Oct 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rose Mary Lopez, MBA
Title
President and Ceo
Phone
(520) 721-1887

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X BH3355 AZ Primary

Addresses

Primary practice location

994 S Harrison Rd
Tucson, AZ 85748-6608

Mailing address

PO Box 86537
Tucson, AZ 85754-6537
Phone (520) 721-1887

Other identifiers 2

IdentifierTypeStateIssuer
451145MedicaidAZ
OTC5916OtherAZSTATE LICENSE

Other names 1

  • Harrison994 Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161031002068 AZ Part B Supplier - Clinic/Group Practice 5395023048 Receives reassigned benefits from 20 practitioners
13 other NPIs on this enrollment
Practice locations: Tucson, AZ; Sells, AZ

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Centers for Human Development Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1083846661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 86537",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857546537",
            "telephone_number": "520-721-1887",
            "fax_number": "520-721-0069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 S HARRISON RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857486608",
            "telephone_number": "520-721-1887",
            "fax_number": "520-721-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-17",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "520-721-1887",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "BH3355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "451145",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "OTC5916",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harrison994",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.