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

General Provider Information

NPI Number	:	1730965906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY BRIDGES, INC.

Provider Business Mailing Address
First Line	:	1855 W BASELINE RD STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-9098
Country	:	US
Telephone Number	:	480-831-7566
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 W CLEVELAND
Second Line	:
City	:	ST JOHN'S
State	:	AZ
Zip	:	85936-0579
Country	:	US
Telephone Number	:	928-337-4301
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JOHN HOGEBOOM
Credential	:
Telephone Number	:	480-831-7566

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	09/05/2023

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