Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Yuma Outpatient Services Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
3250 E 40TH ST STE C, YUMA, AZ 85365-7994
(928) 341-4220
(928) 344-4457
Mailing address
1855 W BASELINE RD, SUITE 101, MESA, AZ 85202-9000
(480) 831-7566
(480) 962-7671
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
BH-4045
AZ
251J00000X
Nursing Care Agency
OTC6002
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6002
AZ
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
OTC6002
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC6002
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC6002
AZ
291U00000X
Clinical Medical Laboratory
OTC6002
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC6002
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206501
—
AZ
Enumeration date
02/26/2013
Last updated
02/14/2023
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