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NPI Code Detail

MEDICARE: DCCCA, INC

MEDICARE: DCCCA, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)279KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2929460OTHERKSCENPATICO

General Provider Information

NPI Number : 1699898213
Entity Type Code : Organization
Provider Name (Legal Business Name) : DCCCA, INC
Provider Business Mailing Address
First Line : 3312 CLINTON PKWY
Second Line :
City : LAWRENCE
State : KS
Zip : 66047-3624
Country : US
Telephone Number : 785-841-4138
Fax Number : 785-841-5777
Provider Business Practice Location Address
First Line : 1319 W MAY ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-3505
Country : US
Telephone Number : 316-262-0505
Fax Number : 316-262-7384
Authorized Official
Title or Position : CFO
Name : KERYE J JACKSON
Credential : CPA, CMA
Telephone Number : 785-841-4138
Provider Enumeration Date : 04/09/2007
Last Update Date : 05/29/2020

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Directions to “DCCCA, INC ” Practice Location

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