Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Winslow Outpatient Services Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
110 E SECOND ST, WINSLOW, AZ 86047-3704
(928) 289-1222
(928) 289-1122
Mailing address
1855 W. BASELINE RD., SUITE 101, MESA, AZ 85202-9098
(480) 831-7566
(480) 962-7671
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
BH-3829
AZ
251J00000X
Nursing Care Agency
OTC6949
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6949
AZ
261Q00000X
Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
OTC6949
AZ
261QM0850X
Adult Mental Health Clinic/Center
OTC6949
AZ
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC6949
AZ
261QR1300X
Rural Health Clinic/Center
OTC6949
AZ
291U00000X
Clinical Medical Laboratory
OTC6949
AZ
343900000X
Non-emergency Medical Transport (VAN)
OTC6949
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333246
—
AZ
01
—
Z145164
MEDICARE PTAN
AZ
Enumeration date
02/15/2011
Last updated
09/18/2024
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