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General NPI Number Information
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NPI Number | 1215823406
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Entity Type | Organization
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Legal Business Name | KENOSHA COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 930 DR MARTIN LUTHER KING DR # 3
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City | RACINE
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State | WI
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Zip | 53404-3008
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Country | US
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Telephone | 262-656-0044
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Fax | 262-764-3636
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Provider Business Mailing Address
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Address Line | 4006 WASHINGTON RD
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City | KENOSHA
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State | WI
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Zip | 53144-4819
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Country | US
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Telephone | 262-771-3561
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Fax | 262-764-3636
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Authorized Official
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Title or Position | CFO
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Name | JOHN WILLIAM STAMPFL
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Credential |
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Telephone | 262-771-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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