Provider Demographics
NPI:1295857084
Name:COMMUNITY BRIDGES, INC.
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES, INC.
Other - Org Name:CENTRAL CITY ADDICTION RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOGEBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:480-831-7566
Mailing Address - Street 1:1855 W. BASELINE RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9098
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:480-831-7563
Practice Address - Street 1:2770 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6088
Practice Address - Country:US
Practice Address - Phone:602-273-9999
Practice Address - Fax:602-273-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZIFBH6374251J00000X, 261QP2300X, 276400000X, 291U00000X, 343900000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251J00000XAgenciesNursing Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No291U00000XLaboratoriesClinical Medical Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ145163OtherMEDICARE PTAN
AZ382935Medicaid