Healthcare Provider Details

I. General information

NPI: 1083192215
Provider Name (Legal Business Name): DCC, INC. DBA KIDNEY DIALYSIS AVOIDANCE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W JACKSON BLVD STE 604
CHICAGO IL
60606-6956
US

IV. Provider business mailing address

223 W JACKSON BLVD STE 604
CHICAGO IL
60606-6956
US

V. Phone/Fax

Practice location:
  • Phone: 623-594-3117
  • Fax: 602-714-8853
Mailing address:
  • Phone: 623-594-3117
  • Fax: 602-714-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KEA INGEBORG NIELSEN
Title or Position: SR DIRECTOR, RISK MGMT & COMPLIANCE
Credential:
Phone: 623-594-3117