Healthcare Provider Details

I. General information

NPI: 1275056632
Provider Name (Legal Business Name): OUTREACH COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9120 W HAMPTON AVE STE 119
MILWAUKEE WI
53225-4960
US

IV. Provider business mailing address

711 W CAPITOL DR
MILWAUKEE WI
53206-3328
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-6320
  • Fax:
Mailing address:
  • Phone: 414-964-9018
  • 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: MS. CONSTANCE PALMER
Title or Position: INTERIM CEO
Credential:
Phone: 414-727-6320