Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Payson Outpatient Service Center- 2
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOEGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
803 W MAIN ST, PAYSON, AZ 85541-4993
(480) 831-7566
Mailing address
1855 W BASELINE RD, SUITE 101, MESA, AZ 85202-9000
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
OTC7954
AZ
261Q00000X
Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
OTC7954
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC7954
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC7954
ADHS
AZ
Enumeration date
02/15/2017
Last updated
02/14/2023
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