Organization
COMMUNITY BRIDGES, INC.
Active
Organization
COMMUNITY BRIDGES, INC.
Active
Other names
CBI - Encompass Fredonia Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
170 NORTH MAIN STREET, FREDONIA, AZ 86022
(480) 831-7566
Mailing address
1855 W BASELINE RD STE 101, MESA, AZ 85202-9098
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC11792
ADHS
AZ
Enumeration date
07/12/2022
Last updated
09/18/2024
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