Healthcare Provider Details

I. General information

NPI: 1356461727
Provider Name (Legal Business Name): COMMUNITY BRIDGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

554 S BELLVIEW RM B
MESA AZ
85204-2504
US

IV. Provider business mailing address

1855 W. BASELINE RD. SUITE 101
MESA AZ
85202-9098
US

V. Phone/Fax

Practice location:
  • Phone: 480-649-1141
  • Fax: 480-831-7563
Mailing address:
  • Phone: 480-831-7566
  • Fax: 480-831-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberIFBH6334
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberIFBH6334
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberIFBH6334
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberIFBH6334
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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