Organization
DCCCA, INC
Active
Parent organization
DCCCA, INC
Other names
Elm Acres Recovery Youth Services
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
1002 E MADISON ST, PITTSBURG, KS 66762-6023
(620) 231-6129
(620) 231-0447
Mailing address
3312 CLINTON PKWY, LAWRENCE, KS 66047-3624
(785) 841-4138
(785) 841-5777
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
052
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106740O
—
KS
01
—
1534
BLUE CROSS BLUE SHIELD
KS
01
—
5245784
UNITED BEHAVIORAL HEALTH
KS
Enumeration date
03/28/2007
Last updated
05/27/2020
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