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General NPI Number Information
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NPI Number | 1982119855
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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 | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 824 N 99TH AVE STE 108
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City | AVONDALE
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State | AZ
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Zip | 85323-5327
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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 |
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Authorized Official
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Title or Position | DEPUTY 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 | 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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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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