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General NPI Number Information
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NPI Number | 1710193461
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Entity Type | Organization
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Legal Business Name | BOYS RANCH OF NACOGDOCHES, INC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7245 FM 1275
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City | NACOGDOCHES
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State | TX
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Zip | 75961-3867
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Country | US
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Telephone | 936-569-0293
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Fax | 936-569-7207
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Provider Business Mailing Address
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Address Line | 7245 FM 1275
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City | NACOGDOCHES
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State | TX
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Zip | 75961-3867
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Country | US
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Telephone | 936-569-0293
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Fax | 936-569-7207
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GEORGE WILLIAM HARRISON
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Credential |
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Telephone | 936-569-0293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | TX
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