Community Bridges, Inc.
Organization Active NPI Adult Mental Health Clinic/Center · Page, AZ
NPI 1558095315 · NPPES record last updated Apr 14, 2023
Key facts
- NPI
- 1558095315
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Mental Health Clinic/Center 261QM0850X
- Legal business name
- COMMUNITY BRIDGES, INC.
- Practice address
- 463 South Lake Powell Boulevard
Page, AZ 86040 - Phone
- (480) 831-7566
- NPI assigned
- Jul 15, 2022
- Organization subpart
- No
Authorized official
- Name
- John Hogeboom
- Title
- President/Ceo
- Phone
- (480) 831-7566
Other NPIs on the same Medicare enrollment 28
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 24
Practitioners 147
-
Marieclaire Mbah Acha, PMHNP
-
Babatomiwa Aramide Adesanya, PMHNP
-
Mosunmoluwa Adesanya, APRN
-
Enoch Adomako, NP
-
Janette Marisa Albarracin, PMHNP
-
Jennifer Anne Alexander, FNP PMHNP
-
Maura Allen, LPC
-
Mojisola R Balogun, PMHNP
-
Leloole Sole Barika, F.N.P.
-
Matthew Barkman, PMHNP
-
Lafayette Bishop, NP
-
Matilda Boachie, PMHNP
-
Ebenezer Bodude, RN
-
Ian Douglas Bond, MD
-
Asha-Lee Cadogan, NURSE PRACTITIONER
-
Adnan Celjo, M.D.
-
Deborah Jane Clamp, LCSW
-
Tracy Conboy, PMHNP
-
Sandra Degroat, APN
-
Grace Chidinma Ezenwaka, PMHNP
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 Practice locations: Tucson, AZ; Phoenix, AZ; Payson, AZ; Winslow, AZ; Yuma, AZ; Mesa, AZ; Page, AZ; Avondale, AZ… |
National Provider Directory
- Tax ID family
- Community Bridges Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| Clinic/Center | 261Q00000X | |||
| Health Service Clinic/Center | 261QH0100X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | Yes |
Addresses
Primary practice location
463 South Lake Powell Boulevard
Page, AZ 86040
Mailing address
1855 W Baseline Rd Ste 101
Mesa, AZ 85202-9098
Phone (480) 831-7566
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OTC11821 | Other | AZ | ADHS |
Other names
- CBI - Encompass Page Integrated Health Home
Other providers in Page, AZ
- City of Page
- Benjamin Joseph Cluff
- Community Bridges, Inc.
- Community Bridges, Inc.
- Community Bridges, Inc.
- Community Bridges, Inc.
- Sarah Marie Corey
- Michael J Demangone
- Desert Heights Family Clinic Professional Corporation
- Erin Nicole Dial-Duran
All providers in Page, AZ · Adult Mental Health Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 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.