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Community Bridges, Inc.

Organization Active NPI Case Management Agency · Avondale, AZ

NPI 1386137149 · NPPES record last updated Jul 14, 2022

Key facts

NPI
1386137149
Entity type
Organization (NPI type 2)
Primary specialty
Case Management Agency 251B00000X
License
OTC5972 (AZ)
Legal business name
COMMUNITY BRIDGES, INC.
Practice address
824 N 99TH Ave Ste 107-108
Avondale, AZ 85323-5324
Phone
(623) 907-1457
NPI assigned
Jun 7, 2018
Organization subpart
No

Authorized official

Name
John Hogeboom
Title
President/Ceo
Phone
(480) 831-7566

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Community Bridges Inc (67 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X OTC5972 AZ Yes
Nursing Care Agency 251J00000X OTC5972 AZ
Community/Behavioral Health Agency 251S00000X OTC5972 AZ
Primary Care Clinic/Center 261QP2300X OTC5972 AZ
Clinical Medical Laboratory 291U00000X OTC5972 AZ
Non-emergency Medical Transport (VAN) 343900000X OTC5972 AZ

Addresses

Primary practice location

824 N 99TH Ave Ste 107-108
Avondale, AZ 85323-5324

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
OTC5972MedicaidAZ

Other names

  • West Valley OSC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 14, 2022.

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1386137149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852029098",
            "telephone_number": "480-831-7566",
            "fax_number": "480-775-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 N 99TH AVE STE 107-108",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853235324",
            "telephone_number": "623-907-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-07",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "HOGEBOOM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "480-831-7566"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AZ",
            "license": "OTC5972",
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "AZ",
            "license": "OTC5972",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC5972",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "OTC5972",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "OTC5972",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "OTC5972",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OTC5972",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Valley OSC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Valley OSC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avondale, AZ

All providers in Avondale, AZ · Case Management Agency in Arizona

Sources for this page

Verify at the official NPI Registry.