Healthcare Provider Details

I. General information

NPI: 1316563026
Provider Name (Legal Business Name): RESILIENT YOUTH & COMMUNITY (RYC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 HILL RD
KETCHIKAN AK
99901-5343
US

IV. Provider business mailing address

PO BOX 7475
KETCHIKAN AK
99901-2475
US

V. Phone/Fax

Practice location:
  • Phone: 907-225-4664
  • Fax: 907-885-6613
Mailing address:
  • Phone: 907-225-4664
  • Fax: 907-885-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DUSTIN ART LARNA
Title or Position: CEO
Credential:
Phone: 907-220-7299