NPIMap

Organization Active NPI

Intermountain Centers for Human Development Inc.

  • Children's Substance Abuse Rehabilitation Facility
  • Tucson, AZ
National Provider Identifier
1497135669
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
Legal business name
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Practice address
2502 N Dodge Blvd Ste 190a
Tucson, AZ 85716-2671
Phone
(520) 618-8800
NPI assigned
Jun 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH-4537 AZ
Children's Substance Abuse Rehabilitation Facility 3245S0500X Primary

Addresses

Primary practice location

2502 N Dodge Blvd Ste 190a
Tucson, AZ 85716-2671

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
BH9011OtherAZSTATE LICENSE

Other names 1

  • Summit Residential 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.

National Provider Directory

National Provider Directory

Locations

2502 N Dodge Blvd
Ste 190A
Tucson, AZ 85716
Phone (520) 618-8800

2502 N Dodge Blvd
Ste 190C
Tucson, AZ 85716

NPI Registry JSON

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702944000000",
    "number": "1497135669",
    "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": "2502 N DODGE BLVD STE 190A",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857162671",
            "telephone_number": "520-618-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "520-721-1887",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA, CPA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH-4537",
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "BH9011",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Residential",
            "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 Dec 19, 2023; 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.