Organization
COMMUNITY BRIDGES, INC
Active
Other names
Lighthouse
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN F HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
3250 E 40TH ST, ROOM B, YUMA, AZ 85365-7994
(928) 341-4220
Mailing address
1855 W. BASELINE RD., SUITE 101, MESA, AZ 85202-9098
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
BH-3480
AZ
291U00000X
Clinical Medical Laboratory
BH-3480
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
BH-3480
AZ
324500000X
Substance Abuse Rehabilitation Facility
BH-3480
AZ
343900000X
Non-emergency Medical Transport (VAN)
BH-3480
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
488183
—
AZ
01
—
Z148077
MEDICARE PTAN
AZ
Enumeration date
01/08/2010
Last updated
01/13/2023
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