Organization
COMMUNITY BRIDGES, INC.
Active
Other names
East Valley Addiction Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN F HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
560 S BELLVIEW, ROOMS B & C, MESA, AZ 85204-2504
(480) 962-7711
(480) 831-7563
Mailing address
1855 W. BASELINE RD, SUITE 101, MESA, AZ 85202-9098
(480) 962-7711
(480) 831-7563
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
IFBH6337
AZ
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
IFBH6337
AZ
291U00000X
Clinical Medical Laboratory
IFBH6337
AZ
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
IFBH6337
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
385867
—
AZ
01
—
Z145163
MEDICARE PTAN
AZ
Enumeration date
04/03/2007
Last updated
02/28/2024
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