| Dccca, Inc | |
|
1319 W May St Suite 1319b Wichita KS 67213-3505 | |
| (316) 267-2030 | |
| (316) 267-2007 |
| Full Name | Dccca, Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1319 W May St, Wichita, Kansas |
| Authorized Official Name and Position | Kerye J Jackson (CFO) |
| Authorized Official Contact | 7858414138 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dccca, Inc 3312 Clinton Pkwy Lawrence KS 66047-3624 Ph: (785) 841-4138 | Dccca, Inc 1319 W May St Suite 1319b Wichita KS 67213-3505 Ph: (316) 267-2030 |
| NPI Number | 1932228533 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 05/27/2020 |
| Certification Date | 05/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932228533 | NPI | - | NPPES |
| 100106740J | Medicaid | KS | |
| 1245 | Other | KS | BLUE CROSS BLUE SHIELD |
| 929460 | Other | KS | CENPATICO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 074 (Kansas) | Primary |
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