INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC. (NPI# 1275904716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275904716 |
| Entity Type | Organization |
| Organization Name | INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT INC. |
| Other Organization Name | BROADWAY |
| Practice Address |
5055 E Broadway Blvd Ste C-104 Tucson AZ 85711-3641 |
| Mailing Address |
Po Box 86537 Tucson AZ 85754-6537 |
| Practice Telephone | 5206239833 |
| Practice Fax Number | 5206239083 |
| Mailing Telephone | 5207211887 |
| Mailing Fax Number | 5207210069 |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | ROSE MARY LOPEZ (PRESIDENT AND CEO) |
| Authorized Official Telephone | 5207211887 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 090219 | 05 | |
| AZ | STATE LICENSE | OTC7327 | 01 |
| Other Name | Type Code |
|---|---|
| Broadway | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336696657 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 276 West View Point Drive, Nogales, AZ 85621 | 2016-09-02 |
| 1659827707 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 1821 N Trekell Rd Ste 1, Casa Grande, AZ 85122-1705 | 2016-08-29 |
| 1578922670 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 401 N Bonita Ave, Tucson, AZ 85745-2750 | 2016-02-17 |
| 1497135669 | Intermountain Centers for Human Development Inc. | Community Based Residential Treatment Facility, Mental Illness | 2200 S Avenida Los Reyes, Tucson, AZ 85748-8213 | 2015-06-03 |
| 1770884157 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 3626 E Lee St, Building 2, Tucson, AZ 85716-3717 | 2010-11-16 |
| 1912208711 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 2902 N Winstel Blvd, Tucson, AZ 85716-2029 | 2010-11-10 |
| 1205164605 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | Bia State Rt 19, Sells, AZ 85634 | 2009-11-23 |
| 1417134933 | Intermountain Centers for Human Development Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1310 N Speedway Pl, Tucson, AZ 85715-5236 | 2008-01-28 |
| 1740378181 | Intermountain Centers for Human Development Inc. | Community Based Residential Treatment Facility, Mental Illness | 3626 E Lee St Bldg 1, Tucson, AZ 85716-3717 | 2006-10-11 |
| 1518055953 | Intermountain Centers for Human Development Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 8571 E Tanque Verde Rd, Tucson, AZ 85749-8917 | 2006-10-11 |
| Street Address |
5055 E BROADWAY BLVD STE C-104 |
| City | TUCSON |
| State | AZ |
| Zip Code | 85711-3641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437306362 | Jon Craig Reardon | Social Worker | 5055 E Broadway Blvd Ste C-104, Tucson, AZ 85711-3641 | 2008-08-21 |
| 1386130318 | Lisa Lenius | Counselor | 5055 E Broadway Blvd Ste C-104, Tucson, AZ 85711-3641 | 2018-07-02 |
| 1083072375 | Letha Grady | Counselor | 5055 E Broadway Blvd Ste C-104, Tucson, AZ 85711-3641 | 2016-02-02 |
| 1093173379 | Laura Jean Stanley | Social Worker | 5055 E Broadway Blvd Ste C-104, Tucson, AZ 85711-3641 | 2016-02-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356959951 | Ridgeline Practice | Counselor | 4625 N Broadway, Suite 105, Tucson, AZ 85711 | 2020-07-20 |
| 1881229946 | Famiglia Amore II LLC | Assisted Living Facility | 632 N. Wilmot, Tucson, AZ 85711 | 2020-03-10 |
| 1992343362 | Laurie Anne Mcmahon | Family Medicine | 899 N. Wilmot, Building B, Tucson, AZ 85711 | 2019-12-17 |
| 1063060093 | Sharese Ann Bailey | Counselor | 300 S Craycroft Rd, Tucson, AZ 85711 | 2019-09-03 |
| 1467940015 | Jin Zhang | Ophthalmology | 655 N Alvernon Way Ste 204, Tucson, AZ 85711 | 2018-04-30 |
| 1447779525 | Catherine Butler Hobart | Pharmacist | 535 North Wilmont Road, Suite 101, Tucson, AZ 85711 | 2017-09-11 |
| 1689196420 | Cope Community Services, Inc. | Case Management | 924 N Alvernon Way, Tucson, AZ 85711 | 2017-07-13 |
| 1124561477 | Regina Maendler | Behavioral Analyst | 630 N. Craycroft Rd, Tucson, AZ 85711 | 2016-11-18 |
| 1881140184 | Elleda Linsmeyer | Speech-Language Pathologist | St. Joesph's Hosptial, 350 N. Wilmont Rd., Tucson, AZ 85711 | 2016-08-28 |
| 1962856260 | Csl-tucson, LLC | Assisted Living Facility | 1020 N. Woodland Avenue, Tucson, AZ 85711 | 2016-04-22 |
| Find all providers in zip 85711 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265047435 | Sarah Mcmillan Counseling Pllc | Community/Behavioral Health | 6460 E Grant Rd # 30661, Tucson, AZ 85715-8800 | 2020-09-14 |
| 1851902274 | Connections Counseling Inc | Community/Behavioral Health | 450 E Navajo Rd, Tucson, AZ 85705-3939 | 2020-08-10 |
| 1619503224 | Willingness Counseling Pllc | Community/Behavioral Health | 5775 S Saddle Ridge Ln, Tucson, AZ 85746-3635 | 2020-03-14 |
| 1174162143 | Buena Vista Recovery, LLC | Community/Behavioral Health | 5151 E Pima St Ste 110, Tucson, AZ 85712-3627 | 2019-12-23 |
| 1053877639 | Getaway Advanced Services LLC | Community/Behavioral Health | 3780 E Felix Blvd, Tucson, AZ 85706-1926 | 2019-02-19 |
| 1255815577 | Jane St. Perre | Community/Behavioral Health | 1955 W Grant Rd Ste 125p, Tucson, AZ 85745-1471 | 2018-09-21 |
| 1225519416 | The University of Arizona | Community/Behavioral Health | 4210 N Campbell Ave, Tucson, AZ 85719-1109 | 2018-08-24 |
| 1497244214 | Sage Counseling, Inc. | Community/Behavioral Health | 2221 E Broadway Blvd Ste 200, Tucson, AZ 85719-6032 | 2018-05-07 |
| 1316440241 | Rob Zonfrelli Counseling LLC | Community/Behavioral Health | 10501 E Seven Generations Way Ste 121, Tucson, AZ 85747-5828 | 2018-03-16 |
| 1730681685 | Casa De Los Ninos, Inc. | Community/Behavioral Health | 1120 N 5th Avenue, Tucson, AZ 85705 | 2018-03-07 |
| Find all providers in TUCSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.