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 |
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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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