1134847569 NPI number — OUTREACH COMMUNITY HEALTH CENTERS, INC

Table of content: (NPI 1134847569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134847569 NPI number — OUTREACH COMMUNITY HEALTH CENTERS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH 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:
Provider Other Organization Name Type Code:
6
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:
1134847569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W CAPITOL 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:
53212-1185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-727-6320
Provider Business Mailing Address Fax Number:
414-727-6328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 W VILLARD AVE
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:
53209-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-727-6320
Provider Business Practice Location Address Fax Number:
414-727-6328
Provider Enumeration Date:
08/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS ROBINSON
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
414-964-9016

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com