Provider Demographics
NPI:1043656101
Name:COMMUNITY BRIDGES
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES
Other - Org Name:COMMUNITY BRIDGES ELDERDAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-688-8840
Mailing Address - Street 1:519 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4356
Mailing Address - Country:US
Mailing Address - Phone:831-688-8840
Mailing Address - Fax:831-688-8302
Practice Address - Street 1:501 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4376
Practice Address - Country:US
Practice Address - Phone:831-458-3481
Practice Address - Fax:831-458-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care