NPIMap

Organization Active NPI

Community Bridges, Inc

Doing business as Lighthouse

  • Mental Illness Community Based Residential Treatment Facility
  • Yuma, AZ
National Provider Identifier
1861722175
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
COMMUNITY BRIDGES, INC
Doing business as
Lighthouse
Practice address
3250 E 40TH St
Room B
Yuma, AZ 85365-7994
Phone
(928) 341-4220
NPI assigned
Jan 8, 2010
Last updated
Jan 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 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
Rural Health Clinic/Center 261QR1300X BH-3480 AZ
Clinical Medical Laboratory 291U00000X BH-3480 AZ
Mental Illness Community Based Residential Treatment Facility 320800000X NU Primary
Psychiatric Residential Treatment Facility 323P00000X BH-3480 AZ
Substance Abuse Rehabilitation Facility 324500000X BH-3480 AZ
Non-emergency Medical Transport (VAN) 343900000X BH-3480 AZ

Addresses

Primary practice location

3250 E 40TH St
Room B
Yuma, AZ 85365-7994

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
488183MedicaidAZ
Z148077OtherAZMEDICARE PTAN

Other names 1

  • Lighthouse 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

Practitioners & affiliated clinicians

Practitioners 93

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 93

NPI Registry JSON

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

{
    "created_epoch": "1262908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1861722175",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 E 40TH ST",
            "address_2": "ROOM B",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853657994",
            "telephone_number": "928-341-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BRIDGES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-08",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "BH-3480",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "BH-3480",
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "AZ",
            "license": "BH-3480",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH-3480",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "BH-3480",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "488183",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z148077",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "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 Jan 13, 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.