COMMUNITY BRIDGES, INC
Medical Laboratory at Javelina Ave, Mesa, AZ

License number
Arizona 03D2036549
Category
Medical Laboratory
Type
Clinical Medical Laboratory
Owner
Name: JOHN HOGEBOOM LISAC
Title: VP/COO
Phone: (480) 831-7566
Address
Address
358 E Javelina Ave SUITE 101, Mesa, AZ 85210
National Provider ID: 1760748909
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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COMMUNITY BRIDGES, INC

Mesa, AZ

Industry:
Individual/Family Services
Doing business as:
Community Bridges
Registration:
Dec 29, 1982
Phone:
(480) 831-7566 (Phone), (480) 755-5070 (Phone)
Addresses:
1855 W Baseline Ave #101, Mesa, AZ 85202 (Physical)
1855 W Baseline Rd, Mesa, AZ 85202
1811 S Alma School Rd, Mesa, AZ 85210
State ID:
-0152679-3
Expiration:
PERPETUAL
Vice-Presidents:
Kerry Remella (President), 1855 W Baseline Rd STE 101, Mesa, AZ 85202 (Physical),Kathleen Kelly (Secretary), 1855 W Baseline Rd STE 101, Mesa, AZ 85202 (Physical),David Shumway (Treasurer), 1855 W Baseline Rd STE 101, Mesa, AZ 85202 (Physical),...
Agent:
Ezra T Clark Iii,63 E Main St #501, Mesa, AZ 85201 (Physical)
Categories:
Physical Therapists

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