NPIMap

Organization Active NPI

Intermountain Centers for Human Development

  • Community Health Clinic/Center
  • Tucson, AZ
National Provider Identifier
1861042012
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT
Practice address
401 N Bonita Ave
Tucson, AZ 85709-5001
Phone
(520) 571-6466
Fax
(520) 721-0069
NPI assigned
Sep 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

401 N Bonita Ave
Tucson, AZ 85709-5001

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
OTC9948OtherAZADHS/BMFL LICENSE
146445MedicaidAZ

Other names 1

  • Intermountain Centers Other name

National Provider Directory

National Provider Directory
Tax ID family
Rhema Home7 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.

Locations

1100 W Fresno St
Tucson, AZ 85745
Phone (520) 225-2100

1020 S Harrison Rd
Unit 100
Tucson, AZ 85748
Phone (502) 721-1887

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1861042012",
    "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": "401 N BONITA AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857095001",
            "telephone_number": "520-571-6466",
            "fax_number": "520-721-0069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS/BMFL LICENSE",
            "identifier": "OTC9948",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146445",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intermountain Centers",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Intermountain Centers",
            "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 Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.