Organization
DCCCA, INC
Active
Parent organization
DCCCA, INC
Other names
DCCCA, Inc Outpatient
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
1739 E 23RD ST, LAWRENCE, KS 66046-5017
(785) 830-8238
(785) 830-8246
Mailing address
3312 CLINTON PKWY, LAWRENCE, KS 66047-3624
(785) 841-4138
(785) 841-5777
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106740C
—
KS
01
—
4997
BLUE CROSS BLUE SHIELD
KS
Enumeration date
03/27/2007
Last updated
05/27/2020
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