INTERMOUNTAIN CENTERS FOR HUMAN DEVELOMENT INC. (NPI# 1417349028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417349028 |
| Entity Type | Organization |
| Organization Name | INTERMOUNTAIN CENTERS FOR HUMAN DEVELOMENT INC. |
| Other Organization Name | AIC PUESTA |
| Practice Address |
8851 East Tanque Verde Tucson AZ 85749 |
| Mailing Address |
Po Box 86537 Tucson AZ 85754-6537 |
| Practice Telephone | 5207211887 |
| Mailing Telephone | 5207211887 |
| Mailing Fax Number | 5207210069 |
| Enumeration Date | 2015-02-19 |
| 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 |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | BH4545 | AZ | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 003289 | 05 | |
| AZ | ADHS/BRFL LICENSE | BH4545 | 01 |
| Other Name | Type Code |
|---|---|
| AIC Puesta | Other Name - Individual/Organization |
| Street Address |
8851 EAST TANQUE VERDE |
| City | TUCSON |
| State | AZ |
| Zip Code | 85749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194197400 | Kristin Palmer | Specialist | 9006 E Eagle Place, Tucson, AZ 85749 | 2015-10-26 |
| 1659776557 | Mahmoud Moghaddami | Nurse Practitioner | 1075 E Ft Lowell, Tucson, AZ 85749 | 2014-11-04 |
| 1255632295 | John Leroy Kallmeyer, M.d. | Obstetrics & Gynecology | 11122 E. Rusty Spur Pl., Tucson, AZ 85749 | 2010-11-08 |
| 1861708547 | Nancy H Mcgibbon | Physical Therapist | 8920 E. Woodland Rd, Tucson, AZ 85749 | 2010-08-19 |
| 1366773103 | Lee J Weisbard | Pharmacist | 9115 E Tanque Verde Road, Tucson, AZ 85749 | 2010-01-19 |
| 1568612869 | Southwest Surgical Services | Specialist/Technologist, Other | 12125 E. Quesada Place, Tucson, AZ 85749 | 2008-09-23 |
| 1841456589 | David Dietz | Counselor | 1795 W. Drexel, Tucson, AZ 85749 | 2008-08-01 |
| 1124203682 | Marilou Errazo-searles | Registered Nurse | 11109 E Tanque Verde Rd, Tucson, AZ 85749 | 2008-01-03 |
| 1427142074 | Rgl Development, LLC | Assisted Living Facility | 9050 E Tanque Verde Road, Tucson, AZ 85749 | 2006-10-03 |
| 1760422414 | Katherine L Mcewan | Physical Therapist | 8987 E Tangue Verde Road #301, Tucson, AZ 85749 | 2006-06-08 |
| Find all providers in zip 85749 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033756358 | Native Music Coalition | Residential Treatment Facility, Emotionally Disturbed Children | 5150 S Crazy Cat Ln, Tucson, AZ 85735 | 2019-12-05 |
| 1538668983 | Starks Homes LLC | Residential Treatment Facility, Emotionally Disturbed Children | 7325 E Fayette St, Tucson, AZ 85730-2324 | 2018-02-12 |
| 1063749521 | Casa De Tucson LLC | Residential Treatment Facility, Emotionally Disturbed Children | 5055 W Pima Farms Rd, Tucson, AZ 85741-4736 | 2009-11-04 |
| 1417128950 | New Beginnings Treatment Center, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2937 N Stone Ave, Tucson, AZ 85705-5915 | 2008-03-12 |
| 1417134933 | Intermountain Centers for Human Development Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1310 N Speedway Pl, Tucson, AZ 85715-5236 | 2008-01-28 |
| 1518142033 | La Paloma Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 870 W Miracle Mile Bldg 2, Tucson, AZ 85705-3708 | 2008-01-03 |
| 1538341458 | New Beginnings Treatment Center, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2445 N Oracle Rd, Tucson, AZ 85705-4321 | 2007-12-03 |
| 1467661470 | Pascua Yaqui Tribe | Residential Treatment Facility, Emotionally Disturbed Children | 2861 W Via Hacienda, Tucson, AZ 85741-3424 | 2007-05-22 |
| 1477766723 | La Paloma Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 1718 N Mckinley Ave, Tucson, AZ 85712-3726 | 2007-05-07 |
| 1225187552 | Supported Living Systems | Residential Treatment Facility, Emotionally Disturbed Children | 5501 E 8th St, Tucson, AZ 85711-3209 | 2007-01-09 |
| 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.