Community Bridges, Inc.
Organization Active NPI Community/Behavioral Health Agency · Phoenix, AZ
NPI 1922559624 · NPPES record last updated Jan 13, 2023
Key facts
- NPI
- 1922559624
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- COMMUNITY BRIDGES, INC.
- Practice address
- 1125 W Jackson St
Phoenix, AZ 85007-3110 - Phone
- (480) 831-7566
- NPI assigned
- Oct 18, 2016
- Organization subpart
- No
Authorized official
- Name
- John Hogeboom
- Title
- President/Ceo
- Phone
- (480) 831-7566
Corporate family (same tax ID) 15
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2157684 | Phoenix Rise | Certificate of waiver | Nov 8, 2026 |
National Provider Directory
- Tax ID family
- Community Bridges Inc
Locations
1125 W Jackson St
Phoenix, AZ 85007
Phone (602) 393-9930
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Community/Behavioral Health Agency | 251S00000X | Yes | ||
| Non-emergency Medical Transport (VAN) | 343900000X |
Addresses
Primary practice location
1125 W Jackson St
Phoenix, AZ 85007-3110
Mailing address
1855 W Baseline Rd
Ste. #101
Mesa, AZ 85202-9000
Phone (480) 831-7566
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OTC9247 | Other | AZ | ADHS |
Other names
- Phoenix Rise
Other providers in Phoenix, AZ
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All providers in Phoenix, AZ · Community/Behavioral Health Agency in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.