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General NPI Number Information
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NPI Number | 1083557060
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Entity Type | Organization
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Legal Business Name | KCCDD, INC.
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Dates
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Enumeration Date | 04/13/2026
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Last Update Date | 04/13/2026
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Provider Practice Location Address
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Address Line | 2015 WINDISH DR
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City | GALESBURG
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State | IL
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Zip | 61401-9774
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Country | US
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Telephone | 309-344-2600
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Fax | 309-344-1754
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Provider Business Mailing Address
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Address Line | 2015 WINDISH DR
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City | GALESBURG
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State | IL
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Zip | 61401-9774
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Country | US
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Telephone | 309-344-2600
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Fax | 309-344-1754
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JEFFREY NEAL GOMER
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Credential | CMA,CIA,CFM,CBM
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Telephone | 309-344-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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