Provider Demographics
NPI:1710193461
Name:BOYS RANCH OF NACOGDOCHES, INC
Entity Type:Organization
Organization Name:BOYS RANCH OF NACOGDOCHES, INC
Other - Org Name:NACOGDOCHES BOYS RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-569-0293
Mailing Address - Street 1:7245 FM 1275
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-3867
Mailing Address - Country:US
Mailing Address - Phone:936-569-0293
Mailing Address - Fax:936-569-7207
Practice Address - Street 1:7245 FM 1275
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-3867
Practice Address - Country:US
Practice Address - Phone:936-569-0293
Practice Address - Fax:936-569-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children