NPIMap

Organization Active NPI

Community Bridges, Inc.

Doing business as Winslow Outpatient Services Center

  • Community/Behavioral Health Agency
  • Winslow, AZ
National Provider Identifier
1851698666
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
OTC6949 Issued in AZ
Legal business name
COMMUNITY BRIDGES, INC.
Doing business as
Winslow Outpatient Services Center
Practice address
110 E Second St
Winslow, AZ 86047-3704
Phone
(928) 289-1222
Fax
(928) 289-1122
NPI assigned
Feb 15, 2011
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

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

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X BH-3829 AZ
Nursing Care Agency 251J00000X OTC6949 AZ
Clinic/Center 261Q00000X NU
Health Service Clinic/Center 261QH0100X OTC6949 AZ
Adult Mental Health Clinic/Center 261QM0850X OTC6949 AZ
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X OTC6949 AZ
Rural Health Clinic/Center 261QR1300X OTC6949 AZ
Clinical Medical Laboratory 291U00000X OTC6949 AZ
Non-emergency Medical Transport (VAN) 343900000X OTC6949 AZ
Community/Behavioral Health Agency 251S00000X OTC6949 AZ Primary

Addresses

Primary practice location

110 E Second St
Winslow, AZ 86047-3704

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
333246MedicaidAZ
Z145164OtherAZMEDICARE PTAN

Other names 1

  • Winslow Outpatient Services 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…

Other NPIs on the same Medicare enrollment 28

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

View all 28

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1851698666",
    "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": "480-962-7671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E SECOND ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473704",
            "telephone_number": "928-289-1222",
            "fax_number": "928-289-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "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",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISAC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AZ",
            "license": "BH-3829",
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "OTC6949",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC6949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "333246",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z145164",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Winslow Outpatient Services Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Winslow Outpatient Services Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winslow, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.