1649559642 NPI number — SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.

Table of content: (NPI 1649559642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649559642 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:
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:
1649559642
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 778789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-8789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-672-1353
Provider Business Mailing Address Fax Number:
262-408-5094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 W WASHINGTON 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:
53204-2310
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:
262-408-5094
Provider Enumeration Date:
08/08/2011

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:
414-803-6395

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: "Y" .

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

  • Identifier: 1649559642 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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