Organization
COMMUNITY BRIDGES
Active
Other names
Lift Line
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMON CANCINO (CHIEF EXECUTIVE OFFICER)
(831) 688-8840
Entity
Organization
Contact information
Practice address
545 OHLONE PARKWAY, WATSONVILLE, CA 95076-6685
(831) 688-9663
(831) 688-8302
Mailing address
519 MAIN STREET, WATSONVILLE, CA 95076-4356
(831) 688-8840
(831) 688-8302
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN00367F
MEDI CAL
CA
01
—
MTN0036F
MEDI CAL
CA
Enumeration date
05/03/2007
Last updated
06/03/2023
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