Provider Demographics
NPI:1275737785
Name:DCCCA, INC.
Entity Type:Organization
Organization Name:DCCCA, INC.
Other - Org Name:DCCCA FAMILY PRESERVATION EL DORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KERYE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CMA
Authorized Official - Phone:785-841-4138
Mailing Address - Street 1:3312 CLINTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3624
Mailing Address - Country:US
Mailing Address - Phone:785-841-4138
Mailing Address - Fax:785-841-5777
Practice Address - Street 1:119 JONES ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-1469
Practice Address - Country:US
Practice Address - Phone:316-322-9600
Practice Address - Fax:316-322-9602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DCCCA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-11
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251B00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management