Organization
COMMUNITY BRIDGES, INC.
Active
Other names
99th Ave ACT
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
824 N 99TH AVE STE 107-108, AVONDALE, AZ 85323-5324
(623) 907-1457
Mailing address
1855 W BASELINE RD STE 101, MESA, AZ 85202-9098
(480) 831-7566
(480) 775-2457
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
OTC5972
AZ
251S00000X
Community/Behavioral Health Agency
OTC5972
AZ
261QH0100X
Health Service Clinic/Center
OTC5972
AZ
261QM0850X
Adult Mental Health Clinic/Center
Primary
OTC5972
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC5972
AZ
Other
Enumeration date
08/01/2017
Last updated
04/07/2022
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