Healthcare Provider Details

I. General information

NPI: 1245610567
Provider Name (Legal Business Name): COMMUNITY BRIDGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 HERMOSA DR AREA B
HOLBROOK AZ
86025-2036
US

IV. Provider business mailing address

1855 W BASELINE RD SUITE 101
MESA AZ
85202-9000
US

V. Phone/Fax

Practice location:
  • Phone: 928-524-1151
  • Fax:
Mailing address:
  • Phone: 480-831-7566
  • Fax: 480-962-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberBH4570
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH4570
License Number StateAZ

VIII. Authorized Official

Name: JOHN HOGEBOOM
Title or Position: PRESIDENT/CEO
Credential:
Phone: 480-831-7566