Organization
COMMUNITY BRIDGES, INC.
Active
Other names
East Valley Addiction Recovery Center (EVARC)
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN F HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
560 S BELLVIEW RM A, MESA, AZ 85204-2504
(480) 962-7711
(480) 844-8449
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
OTC6336
AZ
251J00000X
Nursing Care Agency
OTC6336
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6336
AZ
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
OTC6336
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC6336
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC6336
AZ
291U00000X
Clinical Medical Laboratory
OTC6336
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC6336
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
453702
—
AZ
01
—
Z145163
MEDICARE PTAN
AZ
Enumeration date
06/07/2006
Last updated
02/14/2023
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