Provider Demographics
NPI:1245720499
Name:OUTREACH COMMUNITY HEALTH CENTERS, INC.
Entity type:Organization
Organization Name:OUTREACH COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:414-727-6320
Mailing Address - Fax:
Practice Address - Street 1:1730 N 7TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1701
Practice Address - Country:US
Practice Address - Phone:414-727-6315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========Medicaid