Provider Demographics
NPI:1275056632
Name:OUTREACH COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:OUTREACH COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:HEALTHCARE FOR THE HOMELESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-727-6320
Mailing Address - Street 1:711 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-3328
Mailing Address - Country:US
Mailing Address - Phone:414-964-9018
Mailing Address - Fax:414-727-6328
Practice Address - Street 1:9120 W HAMPTON AVE STE 119
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4960
Practice Address - Country:US
Practice Address - Phone:414-727-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42219000Medicaid