NPIMap

Organization Active NPI

Intermountain Centers for Human Development Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Tucson, AZ
National Provider Identifier
1740378181
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
BH-1012 Issued in AZ
Legal business name
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.
Practice address
3626 E Lee St BLDG 1
Tucson, AZ 85716-3717
Phone
(520) 319-5477
Fax
(520) 319-5491
NPI assigned
Oct 11, 2006
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
Mental Illness Community Based Residential Treatment Facility 320800000X BH-1012 AZ Primary

Addresses

Primary practice location

3626 E Lee St BLDG 1
Tucson, AZ 85716-3717

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
199176MedicaidAZ
BH1012OtherAZSTATE LICENSE

Other names 1

  • Kiva 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.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1740378181",
    "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": "3626 E LEE ST BLDG 1",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857163717",
            "telephone_number": "520-319-5477",
            "fax_number": "520-319-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "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": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH-1012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199176",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "BH1012",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kiva House",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Kiva 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.