Provider Demographics
NPI:1649410705
Name:COMMUNITY BRIDGES, INC
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGEBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:480-831-7566
Mailing Address - Street 1:1811 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3001
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:
Practice Address - Street 1:1811 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3001
Practice Address - Country:US
Practice Address - Phone:480-831-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ433653Medicaid