Provider Demographics
NPI:1740737196
Name:COMMUNITY BRIDGES, INC.
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES, INC.
Other - Org Name:PLAZA OUTPATIENT SERVICES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CHIEF OPERATING OFFICER
Authorized Official - Prefix:
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 1:1855 W BASELINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9000
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:
Practice Address - Street 1:2502 N DODGE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2671
Practice Address - Country:US
Practice Address - Phone:520-323-1309
Practice Address - Fax:520-323-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7807251B00000X, 251J00000X, 251S00000X, 261QH0100X, 261QM0850X, 261QR0405X, 291U00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC7807OtherADHS