Organization
SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.
Active
Parent organization
SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.
Other names
SSCHC Chavez Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
SIXTEENTH STREET COMMUNITY HEALTH CENTERS, INC.
Authorized official
MARIA CECILIA S TAYLOR (CFO)
(414) 803-6395
Entity
Organization
Contact information
Practice address
1032 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2203
(414) 672-1353
(262) 408-5094
Mailing address
PO BOX 778789, CHICAGO, IL 60677-8789
(414) 672-1353
(262) 408-5094
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841255577
—
WI
Enumeration date
04/18/2006
Last updated
05/03/2023
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