IndividualActive
Gerald Johnson
NPI 1609443217 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Wasilla, AK
Provider details
- NPI number
- 1609443217
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Practice location
4092 W Marble Way
Wasilla, AK 99654-8752
Phone: (907) 227-3524
Approximate (ZIP-level) locationGet directions
Mailing address
4092 W Marble Way
Wasilla, AK 99654-8752
Registry dates
- Enumerated
- 2021-06-10
- Last updated
- 2025-10-15
- Certified
- 2025-10-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.