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Mr. Gerald Bruce Johnson SR.
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wasilla, Alaska
NPI 1609443217

Gerald Bruce Johnson SR. is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Anchorage, AK. Gerald Bruce Johnson SR. practices in Wasilla, AK. The NPI Number for Gerald Bruce Johnson SR. is 1609443217 and holds a License No. (Alaska).

The current practice location address for Gerald Bruce Johnson SR. is 4092 W Marble Way, Wasilla, AK and can be reached out via phone at 907-227-3524.

Location: 4092 W Marble Way, Wasilla, AK, 99514-1296
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1609443217
Provider Name
Gerald Bruce Johnson SR.
Credential
Provider Entity Type
Individual
Gender
Male
Address
4092 W Marble Way, Wasilla, AK, 99514-1296
Phone Number
907-227-3524
Fax Number
Provider Enumeration Date
06/10/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1705395 05 AK
institution
Provider Business Practice Location Address Details
Address
4092 W Marble Way
City
Wasilla
State
Alaska
Zip
99654-8752
Phone Number
907-227-3524
Fax Number
person
Provider Business Mailing Address Details
Address
4092 W Marble Way
City
Wasilla
State
Alaska
Zip
99654-8752
Phone Number
907-227-3524
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
(Alaska)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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