NPIMap

Organization Active NPI

Community Bridges, Inc

Doing business as East Valley Addiction Recovery Center

  • Clinical Medical Laboratory
  • Mesa, AZ
National Provider Identifier
1275769440
Registry record updated Jun 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
03D1081388 Issued in AZ
Legal business name
COMMUNITY BRIDGES, INC
Doing business as
East Valley Addiction Recovery Center
Practice address
560 S Bellview
Mesa, AZ 85204-2504
Phone
(480) 962-7711
Fax
(480) 844-8449
NPI assigned
Jun 2, 2009
Last updated
Jun 10, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY BRIDGES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John F Hogeboom, LISAC
Title
VP/Coo
Phone
(480) 831-7566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 03D1081388 AZ Primary

Addresses

Primary practice location

560 S Bellview
Mesa, AZ 85204-2504

Mailing address

1811 S Alma School Rd
Suite 160
Mesa, AZ 85210-3001
Phone (480) 831-7566

Other names 1

  • East Valley Addiction Recovery Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1081388Community Bridges560 S Bellview, Mesa, AZ 85204Certificate of waiverMar 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Bridges Inc66 organizations share this tax ID, including this one
Part of
Community Bridges Inc

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

560 S Bellview
Mesa, AZ 85204
Phone (480) 962-7711

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244592000000",
    "number": "1275769440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 S ALMA SCHOOL RD",
            "address_2": "SUITE 160",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852103001",
            "telephone_number": "480-831-7566",
            "fax_number": "480-962-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 S BELLVIEW",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852042504",
            "telephone_number": "480-962-7711",
            "fax_number": "480-844-8449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY BRIDGES, INC",
        "enumeration_date": "2009-06-02",
        "last_updated": "2009-06-10",
        "status": "A",
        "authorized_official_last_name": "HOGEBOOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VP/COO",
        "authorized_official_telephone_number": "480-831-7566",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISAC"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D1081388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Valley Addiction Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.