Organization Name: | OVER THE EDGE GROUP HOME FOR DISABLE |
NPI Number: | 1598058232 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AUTRELL SHERROD BROWN (OWNER/CEO) |
Mailing Address: | 7010 Phoenix Ave Ne Apt 310 Albuquerque |
State: | NM US |
Postal Code: | 871103505 |
Phone Number: | 5055085708 |
Fax Number: | |
NPI Enumeration Date: | 05/26/2011 |
NPI Last Update Date: | 05/26/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |