Organization
DCCCA, INC
Active
Parent organization
DCCCA, INC
Other names
DCCCA Pratt
Organization subpart
Yes
Provider details
NPI number
Legal business name
DCCCA, INC
Authorized official
KERYE J JACKSON CPA, CMA (CFO)
(785) 841-4138
Entity
Organization
Contact information
Practice address
501 S. NINNESCAH, PRATT, KS 67124-2838
(620) 672-7546
(620) 672-7148
Mailing address
3312 CLINTON PKWY, LAWRENCE, KS 66047-3624
(785) 841-4138
(785) 841-5777
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200655670T
—
KS
Enumeration date
10/02/2006
Last updated
05/28/2020
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