Provider Demographics
NPI:1306909197
Name:RESILIENT YOUTH & COMMUNITY (RYC)
Entity type:Organization
Organization Name:RESILIENT YOUTH & COMMUNITY (RYC)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:2514 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5804
Mailing Address - Country:US
Mailing Address - Phone:907-225-4664
Mailing Address - Fax:907-885-6613
Practice Address - Street 1:2524 FIRST AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5804
Practice Address - Country:US
Practice Address - Phone:907-225-4664
Practice Address - Fax:907-885-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK322D00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021118Medicaid
AKBR00121Medicaid
AKBR0012Medicaid