Provider Demographics
NPI:1710032669
Name:OUTREACH COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:OUTREACH COMMUNITY HEALTH CENTERS, INC
Other - Org Name:HEALTH CARE FOR THE HOMELESS OF MILWAUKEE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-964-9016
Mailing Address - Street 1:220 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1185
Mailing Address - Country:US
Mailing Address - Phone:414-374-2400
Mailing Address - Fax:414-374-7903
Practice Address - Street 1:220 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1185
Practice Address - Country:US
Practice Address - Phone:414-906-1943
Practice Address - Fax:414-727-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QF0400X
WI2246251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI521816Medicare Oscar/Certification