Organization
OVER THE EDGE GROUP HOME FOR DISABLE
Active
Organization
OVER THE EDGE GROUP HOME FOR DISABLE
Active
Other names
over the edge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AUTRELL SHERROD BROWN (OWNER/CEO)
(505) 463-6328
Entity
Organization
Contact information
Practice address
7010 PHOENIX AVE NE APT 310, ALBUQUERQUE, NM 87110-3505
(505) 508-5708
Mailing address
7010 PHOENIX AVE NE APT 310, ALBUQUERQUE, NM 87110-3505
(505) 508-5708
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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