Provider Demographics
NPI:1700098969
Name:COMMUNITY BRIDGES
Entity Type:Organization
Organization Name:COMMUNITY BRIDGES
Other - Org Name:LIFT LINE
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 1:545 OHLONE PARKWAY
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6685
Practice Address - Country:US
Practice Address - Phone:831-688-9663
Practice Address - Fax:831-688-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00367FOtherMEDI CAL
CAMTN0036FOtherMEDI CAL