Organization
COMMUNITY BRIDGES, INC.
Active
Other names
PCMH
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
1520 E PIMA ST, PHOENIX, AZ 85034-4639
(602) 407-6280
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
OTC8969
AZ
251J00000X
Nursing Care Agency
OTC8969
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC8969
AZ
261QH0100X
Health Service Clinic/Center
OTC8969
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC8969
AZ
261QP2300X
Primary Care Clinic/Center
OTC8969
AZ
291U00000X
Clinical Medical Laboratory
OTC8969
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC8969
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC8969
ADHS
AZ
Enumeration date
08/10/2018
Last updated
07/14/2022
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