Organization
COMMUNITY BRIDGES, INC.
Active
Other names
West Valley OSC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
824 N 99TH AVE STE 107-108, AVONDALE, AZ 85323-5324
(623) 907-1457
Mailing address
1855 W BASELINE RD STE 101, MESA, AZ 85202-9098
(480) 831-7566
(480) 775-2457
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
OTC5972
AZ
251J00000X
Nursing Care Agency
OTC5972
AZ
251S00000X
Community/Behavioral Health Agency
OTC5972
AZ
261QP2300X
Primary Care Clinic/Center
OTC5972
AZ
291U00000X
Clinical Medical Laboratory
OTC5972
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC5972
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OTC5972
—
AZ
Enumeration date
06/07/2018
Last updated
07/14/2022
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