Community Bridges, Inc.
Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Bisbee, AZ
NPI 1003353244 · NPPES record last updated Jan 13, 2023
Key facts
- NPI
- 1003353244
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- Legal business name
- COMMUNITY BRIDGES, INC.
- Practice address
- 240 O'Hara Avenue
Bisbee, AZ 85603 - Phone
- (520) 432-8068
- Fax
- (520) 432-6962
- NPI assigned
- Jan 26, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY BRIDGES, INC.
Authorized official
- Name
- John Hogeboom, LISAC
- Title
- Ceo
- Phone
- (480) 831-7566
Other NPIs on the same Medicare enrollment 28
Practitioners 3
-
Latricia Richards-Smith, APRN
-
Michel A Sucher, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110606000388 | AZ | Part B Supplier - Clinic/Group Practice | 2062699721 |
Receives reassigned benefits from 126 practitioners 36 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tucson, AZ; Phoenix, AZ; Payson, AZ; Winslow, AZ; Yuma, AZ; Mesa, AZ; Page, AZ; Avondale, AZ… |
National Provider Directory
- Part of
- Community Bridges Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | Yes | ||
| Substance Abuse Rehabilitation Facility | 324500000X | BH5106 | AZ | |
| Non-emergency Medical Transport (VAN) | 343900000X | BH5106 | AZ |
Addresses
Primary practice location
240 O'Hara Avenue
Bisbee, AZ 85603
Mailing address
1855 W Baseline Rd Ste 101
Mesa, AZ 85202-9098
Phone (480) 831-7566
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BH5106 | Other | AZ | ADHS |
| 237236 | Other | AZ | AHCCCS |
Other names
- Women's Transition Project
Other providers in Bisbee, AZ
- Chiricahua Community Health Centers, Inc.
- City of Bisbee
- City of Bisbee Ambulance
- Cochise County
- W Patrick Coghlan
- Community Intervention Associates, Inc.
- Cheryl Dehaven
- Arleene Evelynne Djordjevic
- Daniel Abram Driscoll
- Jennifer E. Druckman
All providers in Bisbee, AZ · Mental Illness Community Based Residential Treatment Facility in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.