Organization
COMMUNITY BRIDGES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HOGEBOOM LISAC (VP/COO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
1811 S ALMA SCHOOL RD, SUITE 160, MESA, AZ 85210-3001
(480) 831-7566
Mailing address
1811 S ALMA SCHOOL RD, SUITE 160, MESA, AZ 85210-3001
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433653
—
AZ
Enumeration date
03/03/2009
Last updated
06/15/2009
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