| Residential Youth Care, Inc. | |
|
2524 1st Avenue Ketchikan AK 99901 | |
| (907) 225-4664 | |
| (907) 885-6613 |
| Full Name | Residential Youth Care, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2524 1st Avenue, Ketchikan, Alaska |
| Authorized Official Name and Position | Dustin Art Larna (CHIEF FINANCIAL OFFICER & CHIEF OPE) |
| 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) 312-7851 | Residential Youth Care, Inc. 2524 1st Avenue Ketchikan AK 99901 Ph: (907) 225-4664 |
| NPI Number | 1336771781 |
|---|---|
| Provider Enumeration Date | 02/04/2020 |
| Last Update Date | 02/04/2020 |
| Certification Date | 02/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336771781 | NPI | - | NPPES |
| 1584706 | Medicaid | AK | |
| 1021118 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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Residential Youth Care, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3955 S Tongass Hwy, Ketchikan, AK 99901 Phone: 907-220-7299 Fax: 907-885-6613 | |
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