Organization
COMMUNITY BRIDGES, INC.
Active
Other names
Dodge Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN HOGEBOOM LISAC (PRESIDENT/CEO)
(480) 831-7566
Entity
Organization
Contact information
Practice address
2950 N DODGE BLVD, TUCSON, AZ 85716-2012
(877) 931-9142
Mailing address
1855 W BASELINE RD, SUITE 101, MESA, AZ 85202-9000
(480) 831-7566
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
BH4997
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
BH4997
AZ
324500000X
Substance Abuse Rehabilitation Facility
BH4997
AZ
343900000X
Non-emergency Medical Transport (VAN)
BH4997
AZ
385H00000X
Respite Care
BH4997
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH4997
ADHS
AZ
Enumeration date
08/30/2016
Last updated
01/13/2023
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