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General NPI Number Information
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NPI Number | 1306909197
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Entity Type | Organization
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Legal Business Name | RESILIENT YOUTH & COMMUNITY (RYC)
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2524 FIRST AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5804
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Country | US
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Telephone | 907-225-4664
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Fax | 907-885-6613
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Provider Business Mailing Address
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Address Line | 2514 FIRST AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5804
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Country | US
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Telephone | 907-225-4664
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Fax | 907-885-6613
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Authorized Official
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Title or Position | CEO
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Name | DUSTIN ART LARNA
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Credential |
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Telephone | 907-220-7299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | AK
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