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General NPI Number Information
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NPI Number | 1386137149
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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 | 06/07/2018
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 824 N 99TH AVE STE 107-108
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City | AVONDALE
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State | AZ
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Zip | 85323-5324
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Country | US
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Telephone | 623-907-1457
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Fax |
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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 | 480-775-2457
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | JOHN HOGEBOOM
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Credential |
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | OTC5972
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | OTC5972
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OTC5972
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | OTC5972
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | OTC5972
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | OTC5972
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License Number State | AZ
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