Healthcare Provider Details

I. General information

NPI: 1205318102
Provider Name (Legal Business Name): OUTREACH COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CAPITOL DR
MILWAUKEE WI
53212-1123
US

IV. Provider business mailing address

210 W CAPITOL DR
MILWAUKEE WI
53212-1123
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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