Organization
COMMUNITY BRIDGES, INC
Active
Parent organization
COMMUNITY BRIDGES, INC
Other names
Payson Outpatient Services Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY BRIDGES, INC
Authorized official
MR. JOHN F HOGEBOOM LISAC (VP/COO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
803 W MAIN ST, PAYSON, AZ 85541-4993
(928) 468-0022
(928) 468-0044
Mailing address
1855 W. BASELINE RD, SUITE 101, MESA, AZ 85202-9098
(480) 831-7566
(480) 962-7671
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
OTC6017
AZ
251J00000X
Nursing Care Agency
OTC6017
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6017
AZ
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
OTC6017
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC6017
AZ
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC6017
AZ
261QR1300X
Rural Health Clinic/Center
OTC6017
AZ
291U00000X
Clinical Medical Laboratory
OTC6017
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC6017
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
357379
—
AZ
01
—
Z145164
MEDICARE PTAN
AZ
Enumeration date
08/11/2008
Last updated
09/18/2024
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