Organization
COMMUNITY BRIDGES, INC.
Active
Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Mesa Heritage Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
460 N MESA DR STE 201, MESA, AZ 85201-5957
(555) 048-0838
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
OTC8918
AZ
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
OTC8918
AZ
261QP2300X
Primary Care Clinic/Center
OTC8918
AZ
291U00000X
Clinical Medical Laboratory
OTC8918
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424605
—
AZ
01
—
OTC8918
ADHS
AZ
Enumeration date
05/15/2018
Last updated
08/02/2024
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