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General NPI Number Information
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NPI Number | 1639044365
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Entity Type | Organization
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Legal Business Name | DCCCA, INC
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Dates
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Enumeration Date | 10/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 6950 SQUIBB RD STE 400
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City | MISSION
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State | KS
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Zip | 66202-3258
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Country | US
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Telephone | 785-841-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 3312 CLINTON PKWY
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City | LAWRENCE
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State | KS
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Zip | 66047-3624
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Country | US
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Telephone | 785-841-4138
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Fax | 785-841-5777
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Authorized Official
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Title or Position | CFO
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Name | KERYE J JACKSON
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Credential | CPA, CMA
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Telephone | 785-841-4138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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