Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Toole Outpatient Service Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
250 S TOOLE AVE, SUITE C, TUCSON, AZ 85701-1814
(480) 831-7566
(480) 831-7576
Mailing address
1855 W BASELINE RD, SUITE 101, MESA, AZ 85202-9000
(480) 831-7566
(480) 831-7576
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
OTC8024
AZ
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
OTC8024
AZ
291U00000X
Clinical Medical Laboratory
OTC8024
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC8024
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
238225
AHCCCS
AZ
01
—
OTC8024
ADHS
AZ
Enumeration date
02/02/2017
Last updated
02/14/2023
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