# AMERICAN EAGLE BOYS RANCH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669644167
- **Authorized official:** MR. NEIL HANSEN (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (928) 726-6764

## Contact information

- **Practice address:** 3536 W VENUS DR, SOMERTON, AZ 85350-7245
- **Practice address phone:** (928) 726-6764
- **Mailing address:** PO BOX 508, YUMA, AZ 85366-0508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH-2805 | AZ | Yes |

## Other

- **Enumeration date:** 03/25/2008
- **Last updated:** 03/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 921850 | — | AZ |