NPIMap

Organization Active NPI

Community Bridges, Inc.

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1295857084
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
COMMUNITY BRIDGES, INC.
Practice address
2770 E Van Buren St
Phoenix, AZ 85008-6088
Phone
(602) 273-9999
Fax
(602) 273-9040
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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
President/Ceo
Phone
(480) 831-7566

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X IFBH6374 AZ
Primary Care Clinic/Center 261QP2300X IFBH6374 AZ
Substance Use Disorder Rehabilitation Hospital Unit 276400000X IFBH6374 AZ
Clinical Medical Laboratory 291U00000X IFBH6374 AZ
Substance Abuse Rehabilitation Facility 324500000X Primary
Non-emergency Medical Transport (VAN) 343900000X IFBH6374 AZ

Addresses

Primary practice location

2770 E Van Buren St
Phoenix, AZ 85008-6088

Mailing address

1855 W. Baseline Rd.
Suite 101
Mesa, AZ 85202-9098
Phone (480) 831-7566

Other identifiers 2

IdentifierTypeStateIssuer
Z145163OtherAZMEDICARE PTAN
382935MedicaidAZ

Other names 1

  • Central City Addiction Recovery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1295857084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W. BASELINE RD.",
            "address_2": "SUITE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852029098",
            "telephone_number": "480-831-7566",
            "fax_number": "480-831-7563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 E VAN BUREN ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086088",
            "telephone_number": "602-273-9999",
            "fax_number": "602-273-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "HOGEBOOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "480-831-7566",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISAC"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "AZ",
            "license": "IFBH6374",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "IFBH6374",
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "AZ",
            "license": "IFBH6374",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "IFBH6374",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "IFBH6374",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z145163",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "382935",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central City Addiction Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central City Addiction Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.