Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Recovery Navigation Program Central
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
1520 E PIMA ST, PHOENIX, AZ 85034-4639
(602) 407-6280
Mailing address
1855 W BASELINE RD STE 101, MESA, AZ 85202-9098
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407986
—
AZ
Enumeration date
04/27/2021
Last updated
04/07/2022
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