1174910012 NPI number — SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC

Table of content: (NPI 1174910012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174910012 NPI number — SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIXTEENTH STREET COMMUNITY HEALTH CENTERS, 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:
ST ANTHONY SCHOOL
Provider Other Organization Name Type Code:
5
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:
1174910012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1337 S CESAR E CHAVEZ DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53204-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-385-6299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1727 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53204-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-672-1353
Provider Business Practice Location Address Fax Number:
414-385-7552
Provider Enumeration Date:
04/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
MARIA CECILIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
414-897-5407

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  1507-800 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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