Organization
AMERICAN EAGLE BOYS RANCH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL HANSEN (OWNER/ADMINISTRATOR)
(928) 726-6764
Entity
Organization
Contact information
Practice address
3536 W VENUS DR, SOMERTON, AZ 85350-7245
(928) 726-6764
Mailing address
PO BOX 508, YUMA, AZ 85366-0508
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-2805
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
921850
—
AZ
Enumeration date
03/25/2008
Last updated
03/25/2008
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