Healthcare Provider Details

I. General information

NPI: 1215487384
Provider Name (Legal Business Name): COMMUNITY BRIDGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N DODGE BLVD SUITE 190
TUCSON AZ
85716-2671
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 520-323-1309
  • Fax: 520-323-1315
Mailing address:
  • Phone: 480-831-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberIFBH7808
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberIFBH7808
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberIFBH7808
License Number StateAZ

VIII. Authorized Official

Name: JOHN HOGEBOOM
Title or Position: VP/CHIEF OPERATING OFFICER
Credential: LISAC
Phone: 480-831-7566