1932227683 NPI number — DCCCA, INC

Table of content: (NPI 1932227683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932227683 NPI number — DCCCA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DCCCA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOMEN'S RECOVERY CENTER TOPEKA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932227683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3312 CLINTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66047-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-841-4138
Provider Business Mailing Address Fax Number:
785-841-5777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2930 SW WANAMAKER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-233-5885
Provider Business Practice Location Address Fax Number:
785-233-1342
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
KERYE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
785-841-4138

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  237 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000000018 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100106740B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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