NPIMap

Organization Active NPI

Community Bridges, Inc

Doing business as Yuma Lighthouse

  • Clinical Medical Laboratory
  • Yuma, AZ
National Provider Identifier
1477800308
Registry record updated Aug 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
03D2039695 Issued in AZ
Legal business name
COMMUNITY BRIDGES, INC
Doing business as
Yuma Lighthouse
Practice address
3250 B East 40TH Street
Yuma, AZ 85365
Phone
(928) 341-4220
Fax
(928) 344-4457
NPI assigned
Aug 9, 2012
Last updated
Aug 9, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY BRIDGES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2012

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 03D2039695 AZ Primary

Addresses

Primary practice location

3250 B East 40TH Street
Yuma, AZ 85365

Mailing address

1855 W Baseline Rd
Suite 101
Mesa, AZ 85202-9000
Phone (480) 831-7566

Other names 1

  • Yuma Lighthouse 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
03D2039695Community Bridges, Inc - Yuma Lighthouse3250 B East 40TH Street, Yuma, AZ 85365Certificate of waiverApr 15, 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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344470400000",
    "number": "1477800308",
    "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": "852029000",
            "telephone_number": "480-831-7566",
            "fax_number": "480-692-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 B EAST 40TH STREET",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "85365",
            "telephone_number": "928-341-4220",
            "fax_number": "928-344-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY BRIDGES, INC",
        "enumeration_date": "2012-08-09",
        "last_updated": "2012-08-09",
        "status": "A",
        "authorized_official_last_name": "HOGEBOOM",
        "authorized_official_first_name": "JOHN",
        "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": "03D2039695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yuma Lighthouse",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; 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.