Mr. Gerald Bruce Johnson
Mr. Gerald Bruce Johnson is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wasilla, Alaska. Practices as a sole proprietor. Licensed in Alaska.
- Licensed in
- AK
- In the registry since
- 2021
Practice location Address checks out
4092 W Marble WayWasilla, AK 99654-8752
Phone: (907) 227-3524
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Specialties & licences
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) | Taxonomy 320900000X (AK) |
|---|
Record details
| NPI number | 1609443217 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | June 10, 2021 |
| Last updated in NPPES | October 15, 2025 |
| Certification date | October 15, 2025 |
| Mailing address | 4092 W Marble Way, Wasilla, AK 99654-8752 |
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