| Organization Name: | COMMUNITY BRIDGES, INC |
| NPI Number: | 1295037059 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN HOGEBOOM (COO) |
| Mailing Address: | 646 W Union St Benson |
| State: | AZ US |
| Postal Code: | 856026713 |
| Phone Number: | 5205869546 |
| Fax Number: | |
| NPI Enumeration Date: | 11/30/2010 |
| NPI Last Update Date: | 02/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | SABH6938 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |