Organization
DCCCA, INC
Active
Parent organization
DCCCA, INC.
Other names
Women's Recovery Center of Western KS
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
1410 N VINE ST, HOISINGTON, KS 67544-1557
(620) 653-7385
(620) 653-4011
Mailing address
3312 CLINTON PKWY, LAWRENCE, KS 66047-3624
(785) 841-4138
(785) 841-5777
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
350
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106740H
—
KS
01
—
956
BLUE CROSS BLUE SHIELD
KS
Enumeration date
03/27/2007
Last updated
05/29/2020
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