Healthcare Provider Details

I. General information

NPI: 1346380755
Provider Name (Legal Business Name): RACINE COUNTY OPPORTUNITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 SHERIDAN RD
RACINE WI
53403-4142
US

IV. Provider business mailing address

4214 SHERIDAN RD
RACINE WI
53403-4142
US

V. Phone/Fax

Practice location:
  • Phone: 262-554-6515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERYL ANN HAMILTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 262-554-6515