Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Dodge Detoxification Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (VP/CHIEF OPERATING OFFICER)
(480) 831-7566
Entity
Organization
Contact information
Practice address
2502 N DODGE BLVD, SUITE 190, TUCSON, AZ 85716-2671
(520) 323-1309
(520) 323-1315
Mailing address
1855 W BASELINE RD, SUITE 101, MESA, AZ 85202-9000
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
IFBH7808
AZ
291U00000X
Clinical Medical Laboratory
IFBH7808
AZ
343900000X
Non-emergency Medical Transport (VAN)
IFBH7808
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IFBH7808
ADHS
AZ
Enumeration date
10/12/2016
Last updated
10/12/2016
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