Healthcare Provider Details

I. General information

NPI: 1770995409
Provider Name (Legal Business Name): COMPETITIVE EDGE PLUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 S PENNSYLVANIA AVE
OKLAHOMA CITY OK
73170-4900
US

IV. Provider business mailing address

13101 S PENNSYLVANIA AVE
OKLAHOMA CITY OK
73170-4900
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-3542
  • Fax:
Mailing address:
  • Phone: 405-809-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LONNETTA DENISE SMITH
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 405-409-4569