Organization
COMMUNITY BRIDGES, INC.
Active
Other names
CBI Winslow Juvenile Detention Program
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
110 E SECOND ST, WINSLOW, AZ 86047-3704
(928) 289-1122
Mailing address
1855 W BASELINE RD STE 101, MESA, AZ 85202-9098
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH6949
ADHS
AZ
Enumeration date
03/18/2022
Last updated
07/14/2022
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