COMMUNITY BRIDGES, INC. (NPI# 1366722555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366722555 |
| Entity Type | Organization |
| Organization Name | COMMUNITY BRIDGES, INC. |
| Other Organization Name | WEST VALLEY TRANSITION POINT |
| Practice Address |
824 N 99th Ave Suite 109 Avondale AZ 85323-5315 |
| Mailing Address |
1855 W. Baseline Rd. Suite 101 Mesa AZ 85202-9098 |
| Practice Telephone | 4808317566 |
| Mailing Telephone | 4808317566 |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2018-09-19 |
| Authorized Official Name | JOHN F HOGEBOOM (DEPUTY CEO) |
| Authorized Official Telephone | 4808317566 |
| Authorized Official Credential | LISAC |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMUNITY BRIDGES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 291U00000X | Clinical Medical Laboratory | Laboratories | ||
| N | 343900000X | Non-emergency Medical Transport (VAN) | Transportation Services | ||
| N | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities | ||
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | MEDICARE PTAN | Z145163 | 01 |
| Other Name | Type Code |
|---|---|
| West Valley Inpatient | Doing Business As Name - Organization |
| West Valley Transition Point | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417439936 | Community Bridges, Inc. | Clinical Medical Laboratory | 250 S Toole Ave Ste 110, Tucson, AZ 85701-1814 | 2018-08-31 |
| 1346722196 | Community Bridges, Inc. | Clinic/Center | 250 S Toole Ave Ste 130, Tucson, AZ 85701-1814 | 2018-08-29 |
| 1831678721 | Community Bridges, Inc. | Nursing Care | 1520 E Pima St Ste 101, Phoenix, AZ 85034-4639 | 2018-08-10 |
| 1972099836 | Community Bridges, Inc. | Nursing Care | 2950 N Dodge Blvd Ste A, Tucson, AZ 85716-2012 | 2018-07-03 |
| 1285127043 | Community Bridges, Inc. | Clinical Medical Laboratory | 358 E Javelina Ave Ste 101, Mesa, AZ 85210-6205 | 2018-06-07 |
| 1861984205 | Community Bridges, Inc. | Case Management | 460 N Mesa Dr Ste 101, Mesa, AZ 85201-5949 | 2018-06-01 |
| 1184136400 | Community Bridges, Inc. | Psychiatric Residential Treatment Facility | 824 N 99th Ave Ste 105, Avondale, AZ 85323-5327 | 2017-10-26 |
| 1568986560 | Community Bridges, Inc. | Case Management | 824 N 99th Ave Ste 108, Avondale, AZ 85323-5327 | 2017-08-01 |
| 1922559624 | Community Bridges, Inc. | Community/Behavioral Health | 1125 W Jackson St, Phoenix, AZ 85007 | 2016-10-18 |
| 1205115631 | Community Bridges, Inc. | Community/Behavioral Health | 824 N 99th Ave, Suite 108, Avondale, AZ 85323-5315 | 2011-08-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | COMMUNITY BRIDGES, INC. | 720 County St., New Bedford, MA 02740 |
| System for Award Management (SAM) Entities | COMMUNITY BRIDGES, INCORPORATED | 8757 Georgia Ave Ste 540, Silver Spring, MD 20910-3751 |
| Street Address |
824 N 99TH AVE SUITE 109 |
| City | AVONDALE |
| State | AZ |
| Zip Code | 85323-5315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205115631 | Community Bridges, Inc. | Community/Behavioral Health | 824 N 99th Ave, Suite 108, Avondale, AZ 85323-5315 | 2011-08-16 |
| 1649835554 | Rey Jericoh Pureza Manalese | Nurse Practitioner | 824 N 99th Ave, Avondale, AZ 85323-5324 | 2019-05-06 |
| 1427438464 | Samantha Esquivias | Nurse Practitioner | 824 N 99th Ave, Avondale, AZ 85323-5324 | 2015-06-04 |
| 1033475272 | Community Bridges, Inc | Clinical Medical Laboratory | 824 N 99th Ave, Suite 109, Avondale, AZ 85323-5315 | 2012-04-02 |
| 1861768095 | Community Bridges, Inc | Clinical Medical Laboratory | 824 N 99th Ave, Suite 108, Avondale, AZ 85323-5315 | 2012-04-02 |
| 1508132820 | Arleen Elloway | Nurse Practitioner | 824 N 99th Ave, Suite 107, Avondale, AZ 85323-5324 | 2012-03-30 |
| 1821365644 | Donna Marie Jordan | Counselor | 824 N 99th Ave, Avondale, AZ 85323-5324 | 2011-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932663994 | Bridgewater Avondale Operations, LLC | Assisted Living Facility | 295 E Van Buren Street, Avondale, AZ 85323 | 2019-01-24 |
| 1104309152 | Carlos Sifuentes | Physical Therapist | 10750 W Mcdowell Rd., Ste. B-210, Avondale, AZ 85323 | 2018-09-14 |
| 1225534688 | Dayna Sue Kaepp | Registered Nurse | 3300 N. Santa Fe Trail, Avondale, AZ 85323 | 2018-04-04 |
| 1407376700 | Amanda Lynn Radcliffe | Nurse Practitioner | 824 N. 99th Ave Ste 108, Avondale, AZ 85323 | 2017-06-27 |
| 1093253361 | Aquatic-n-writing Rehad | Home Health | 12355 West Cocopah Street, Avondale, AZ 85323 | 2017-02-07 |
| 1750838348 | Annette A Alvarez | Specialist/Technologist | 295 W Western Avenue, Avondale, AZ 85323 | 2016-09-01 |
| 1649726886 | Michelle R Dotson | Contractor | 12115 W Van Buren St Apt 1924, Avondale, AZ 85323 | 2016-08-28 |
| 1619370756 | Amanda Mann | Physical Therapy Assistant | 12804 West Hildalgo, Avondale, AZ 85323 | 2014-10-03 |
| 1326459306 | Ma Caubalejo | Physical Therapist | 350 East La Canada Blvd, Avondale, AZ 85323 | 2014-05-13 |
| 1093139545 | Mark Salvador | Physical Therapy Assistant | 11722 W. Mountain View Dr., Avondale, AZ 85323 | 2014-02-04 |
| Find all providers in zip 85323 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
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| 1073171153 | Heart Song Wellness LLC | Clinic/Center | 8617 W Union Hills Dr Ste 100, Peoria, AZ 85382-7001 | 2019-06-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.