Organization
COMMUNITY BRIDGES, INC.
Active
Other names
West Valley Inpatient
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN F HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
824 N 99TH AVE STE 109, AVONDALE, AZ 85323-5327
(480) 831-7566
Mailing address
1855 W. BASELINE RD., SUITE 101, MESA, AZ 85202-9098
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432663
—
AZ
01
—
Z145163
MEDICARE PTAN
AZ
Enumeration date
08/19/2011
Last updated
06/01/2023
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