Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Plaza Outpatient Services Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (VP/CHIEF OPERATING OFFICER)
(480) 831-7566
Entity
Organization
Contact information
Practice address
2502 N DODGE BLVD, SUITE 190, TUCSON, AZ 85716-2671
(520) 323-1309
(520) 323-1315
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
Primary
OTC7807
AZ
251J00000X
Nursing Care Agency
OTC7807
AZ
251S00000X
Community/Behavioral Health Agency
OTC7807
AZ
261QH0100X
Health Service Clinic/Center
OTC7807
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC7807
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC7807
AZ
291U00000X
Clinical Medical Laboratory
OTC7807
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC7807
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC7807
ADHS
AZ
Enumeration date
09/01/2016
Last updated
09/01/2016
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