Healthcare Provider Details

I. General information

NPI: 1306909197
Provider Name (Legal Business Name): RESILIENT YOUTH & COMMUNITY (RYC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 FIRST AVE
KETCHIKAN AK
99901-5804
US

IV. Provider business mailing address

2514 FIRST AVE
KETCHIKAN AK
99901-5804
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 TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateAK

VIII. Authorized Official

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