NPIMap

Organization Active NPI

Over the Edge Group Home for Disable

Doing business as over the edge

  • Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1598058232
Registry record updated May 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
OVER THE EDGE GROUP HOME FOR DISABLE
Doing business as
over the edge
Practice address
7010 Phoenix Ave NE Apt 310
Albuquerque, NM 87110-3505
Phone
(505) 508-5708
NPI assigned
May 26, 2011
Last updated
May 26, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Autrell Sherrod Brown
Title
Owner/Ceo
Phone
(505) 463-6328

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

7010 Phoenix Ave NE Apt 310
Albuquerque, NM 87110-3505

Mailing address

7010 Phoenix Ave NE Apt 310
Albuquerque, NM 87110-3505
Phone (505) 508-5708

Other names 1

  • over the edge Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1598058232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7010 PHOENIX AVE NE APT 310",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871103505",
            "telephone_number": "505-508-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7010 PHOENIX AVE NE APT 310",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871103505",
            "telephone_number": "505-508-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OVER THE EDGE GROUP HOME FOR DISABLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "AUTRELL",
        "authorized_official_middle_name": "SHERROD",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "505-463-6328",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "over the edge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.