Provider Demographics
NPI:1083940431
Name:THE EDGE STRENGTH & CONDITIONING CAMP LLC
Entity Type:Organization
Organization Name:THE EDGE STRENGTH & CONDITIONING CAMP LLC
Other - Org Name:CAMP 357
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATHLETIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:USAW CERTIFIED COACH
Authorized Official - Phone:919-208-3646
Mailing Address - Street 1:PO BOX 41087
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-1087
Mailing Address - Country:US
Mailing Address - Phone:919-208-3646
Mailing Address - Fax:919-740-3237
Practice Address - Street 1:120 GEORGE WILTON DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9205
Practice Address - Country:US
Practice Address - Phone:919-523-8242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty