Organization
COMMUNITY BRIDGES, INC.
Active
Parent organization
COMMUNITY BRIDGES, INC.
Other names
Casa Grande Inpatient
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY BRIDGES, INC.
Authorized official
JOHN F HOGEBOOM LISAC (CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
675 E COTTONWOOD LN STE 140, CASA GRANDE, AZ 85122-2023
(520) 426-0088
(480) 775-2420
Mailing address
1855 W BASELINE RD STE 101, MESA, AZ 85202-9098
(480) 831-7566
(480) 962-7671
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
IFBH9071
AZ
291U00000X
Clinical Medical Laboratory
IFBH9071
AZ
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
IFBH9071
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419223
—
AZ
01
—
IFBH9071
ADHS
AZ
01
—
Z145164
MEDICARE PTAN
AZ
Enumeration date
06/27/2011
Last updated
03/02/2023
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