Newly enumerated
The official enumeration date falls within the documented new-enumeration window.
- Enumeration date is 43 days before observation
Type 2 organization · NPI 1013841337
EDGEWOOD BULLHEAD CITY AZ01 LLC
310400000X · BULLHEAD CITY, AZ
Why this profile is appearing now
Observed change signals
Reported classification
Taxonomies
| Code | Description | Source flag |
|---|---|---|
| 310400000X | 310400000X | Primary |
Taxonomy reporting does not establish licensure, board certification, expertise, or quality.
Longitudinal record
Observed change timeline
- 0 recorded field change s