NPIMap

Organization Active NPI

Intermountain Centers for Human Development Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Tucson, AZ
National Provider Identifier
1417134933
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
BH-2914 Issued in AZ
Legal business name
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Practice address
1310 N Speedway PL
Tucson, AZ 85715-5236
Phone
(520) 731-0635
NPI assigned
Jan 28, 2008
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
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH-2914 AZ Primary

Addresses

Primary practice location

1310 N Speedway PL
Tucson, AZ 85715-5236

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
305538MedicaidAZ
BH2914OtherAZADHS/BRFL LICENSE

Other names 1

  • Angel House 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
This NPI is an additional NPI on the 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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2263793Intermountain Centers for Human1310 N Speedway PL, Tucson, AZ 85715Certificate of waiverJul 4, 2028

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1417134933",
    "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": "1310 N SPEEDWAY PL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857155236",
            "telephone_number": "520-731-0635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-28",
        "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": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH-2914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305538",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS/BRFL LICENSE",
            "identifier": "BH2914",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel House",
            "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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.