Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Benson Outpatient Services Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN F HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
470 S OCOTILLO AVE STE 1, BENSON, AZ 85602-6403
(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
OTC6848
AZ
251J00000X
Nursing Care Agency
OTC6848
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6848
AZ
261QH0100X
Health Service Clinic/Center
OTC6848
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC6848
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC6848
AZ
261QR1300X
Rural Health Clinic/Center
OTC6848
AZ
291U00000X
Clinical Medical Laboratory
OTC6848
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC6848
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
657478
—
AZ
Enumeration date
11/07/2011
Last updated
01/02/2023
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