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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