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NPI Code Detail

MEDICARE: COMMUNITY BRIDGES, INC.

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
1251B00000XCase Management AgencyOTC5972AZ
2251S00000XCommunity/Behavioral Health AgencyOTC5972AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OTC5972OTHERAZADHS

General Provider Information

NPI Number : 1982119855
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 : 824 N 99TH AVE STE 108
Second Line :
City : AVONDALE
State : AZ
Zip : 85323-5327
Country : US
Telephone Number : 623-907-1457
Fax Number :
Authorized Official
Title or Position : DEPUTY CEO
Name : JOHN HOGEBOOM
Credential :
Telephone Number : 480-831-7566
Provider Enumeration Date : 12/13/2017
Last Update Date : 12/13/2017

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Directions to “COMMUNITY BRIDGES, INC. ” Practice Location

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