Provider Demographics
NPI:1316563026
Name:RESIDENTIAL YOUTH CARE, INC.
Entity Type:Organization
Organization Name:RESIDENTIAL YOUTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER & CHIEF OP
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:ART
Authorized Official - Last Name:LARNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-220-7299
Mailing Address - Street 1:P.O. BOX 7475
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901
Mailing Address - Country:US
Mailing Address - Phone:907-225-4664
Mailing Address - Fax:907-885-6613
Practice Address - Street 1:606 HILL ROAD
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-225-4664
Practice Address - Fax:907-885-6613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESIDENTIAL YOUTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK992953OtherAK BUSINESS
AK1021118Medicaid
AK51636DOtherNON-PROFIT CORPORATION
AK1584706Medicaid