# RACINE COMMUNITY HEALTH CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174395792
- **Authorized official:** MRS. RIVA KIMMEL (OPERATIONS MANAGER)
- **Authorized official phone:** (262) 672-2578

## Contact information

- **Practice address:** 930 DR MARTIN LUTHER KING DR \# 17, RACINE, WI 53404-3008
- **Practice address phone:** (262) 800-7242
- **Mailing address:** 930 DR MARTIN LUTHER KING DR \# 17, RACINE, WI 53404-3008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |

## Other

- **Enumeration date:** 10/26/2023
- **Last updated:** 10/26/2023