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General NPI Number Information
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NPI Number | 1003353244
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Entity Type | Organization
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Legal Business Name | COMMUNITY BRIDGES, INC.
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 240 O'HARA AVENUE
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City | BISBEE
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State | AZ
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Zip | 85603
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Country | US
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Telephone | 520-432-8068
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Fax | 520-432-6962
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Provider Business Mailing Address
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Address Line | 1855 W BASELINE RD STE 101
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City | MESA
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State | AZ
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Zip | 85202-9098
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Country | US
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Telephone | 480-831-7566
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Fax | 480-831-7576
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Authorized Official
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Title or Position | CEO
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Name | JOHN HOGEBOOM
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Credential | LISAC
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Telephone | 480-831-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH5106
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | BH5106
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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