| Residential Youth Care, Inc. | |
|
606 Hill Road Ketchikan AK 99901 | |
| (907) 225-4664 | |
| (907) 885-6613 |
| Full Name | Residential Youth Care, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 606 Hill Road, Ketchikan, Alaska |
| Authorized Official Name and Position | Dustin Art Larna (CHIEF FINANCIAL OFFICER & CHIEF OP) |
| Authorized Official Contact | 9072207299 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Residential Youth Care, Inc. P.o. Box 7475 Ketchikan AK 99901 Ph: (907) 225-4664 | Residential Youth Care, Inc. 606 Hill Road Ketchikan AK 99901 Ph: (907) 225-4664 |
| NPI Number | 1316563026 |
|---|---|
| Provider Enumeration Date | 06/18/2020 |
| Last Update Date | 06/18/2020 |
| Certification Date | 06/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316563026 | NPI | - | NPPES |
| 992953 | Other | AK | AK BUSINESS |
| 1021118 | Medicaid | AK | |
| 51636D | Other | AK | NON-PROFIT CORPORATION |
| 1584706 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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