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General NPI Number Information
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NPI Number | 1851698666
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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 | 02/15/2011
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 110 E SECOND ST
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City | WINSLOW
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State | AZ
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Zip | 86047-3704
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Country | US
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Telephone | 928-289-1222
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Fax | 928-289-1122
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Provider Business Mailing Address
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Address Line | 1855 W. BASELINE RD. SUITE 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 | 480-962-7671
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. 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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | BH-3829
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #8
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #9
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #10
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | OTC6949
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License Number State | AZ
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Taxonomy #11
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | OTC6949
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License Number State | AZ
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