Healthcare Provider Details

I. General information

NPI: 1134847569
Provider Name (Legal Business Name): OUTREACH COMMUNITY HEALTH CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W VILLARD AVE
MILWAUKEE WI
53209-4901
US

IV. Provider business mailing address

220 W CAPITOL DR
MILWAUKEE WI
53212-1185
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6320
  • Fax: 414-727-6328
Mailing address:
  • Phone: 414-727-6320
  • Fax: 414-727-6328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JULIA HARRIS ROBINSON
Title or Position: CEO
Credential:
Phone: 414-964-9016