MEDICARE: COMMUNITY BRIDGES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	BH-1453	AZ

General Provider Information

NPI Number	:	1659662468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY BRIDGES, INC

Provider Business Mailing Address
First Line	:	1811 S ALMA SCHOOL RD
Second Line	:	SUITE 160
City	:	MESA
State	:	AZ
Zip	:	85210-3001
Country	:	US
Telephone Number	:	480-831-7566
Fax Number	:	480-962-7671

Provider Business Practice Location Address
First Line	:	358 E JAVELINA AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6207
Country	:	US
Telephone Number	:	480-831-7566
Fax Number	:	480-962-7671

Authorized Official
Title or Position	:	COO
Name	:	JOHN F HOGEBOOM
Credential	:	LISAC
Telephone Number	:	480-831-7566

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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Directions to “COMMUNITY BRIDGES, INC ” Practice Location

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