Healthcare Provider Details

I. General information

NPI: 1285127043
Provider Name (Legal Business Name): COMMUNITY BRIDGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 E JAVELINA AVE STE 101
MESA AZ
85210-6205
US

IV. Provider business mailing address

1855 W BASELINE RD STE 101
MESA AZ
85202-9098
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-3180
  • Fax:
Mailing address:
  • Phone: 480-831-7566
  • Fax: 480-775-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberOTC6023
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberOTC6023
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberOTC6023
License Number StateAZ

VIII. Authorized Official

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