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KENOSHA COMMUNITY HEALTH CENTER, INC.
NPI 1265435960
Clinic/Center - Federally Qualified Health Center (FQHC) in Kenosha, WI

Active since May 27, 2005CLIA Certified · 2 labs
4536 22ND AVE, KENOSHA, WI 53140(262) 656-0044(262) 653-2218 Get Directions Write a Review

NPPES record last updated: February 25, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Kenosha Community Health Center, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENOSHA COMMUNITY HEALTH CENTER, INC. (NPI 1265435960) is a healthcare organization registered as a federally qualified health center (fqhc) in Kenosha, Wisconsin and active in the NPI registry since May 2005. The organization holds 2 active CLIA laboratory certificates and lists Mary Elizabeth Ouimet, Ceo, as its authorized official.

NPPES Registry Identity

NPI1265435960
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameKENOSHA COMMUNITY HEALTH CENTER, INC.
Location Address4536 22ND AVEKenosha, WI 53140-5917
Mailing Address4006 Washington RdKenosha, WI 53144-4819 · (262) 656-0044 · Fax (262) 764-3636
Phone(262) 656-0044
Fax(262) 653-2218
Organization SubpartNo
Authorized OfficialMary Elizabeth OuimetCeo · (262) 771-3561
Enumeration DateMay 27, 2005
Last NPPES UpdateFebruary 25, 2026
NPPES CertifiedFebruary 25, 2026
✔ NPI 1265435960 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 11

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
License✔ Licensed in WI · NONE
Also ListedCounselorTaxonomy 101Y00000X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedDentistTaxonomy 122300000X
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X
Also ListedPsychiatry & Neurology · Child & Adolescent PsychiatryTaxonomy 2084P0804X
Also ListedGeneral PracticeTaxonomy 208D00000X
Also ListedNurse Practitioner · Psychiatric/Mental HealthTaxonomy 363LP0808X
4536 22ND AVE, Kenosha, WI 53140
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Other Identifiers 1

Medicaid32956300WI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare).Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0909220

Kenosha Community Health Center · Kenosha, WI
Active · expires May 17, 2027
CLIA Number52D0909220
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateMay 18, 2025
Certificate Expiration DateMay 17, 2027
Laboratory DirectorDr. Timothy Sanborn
Laboratory Phone(262) 771-3500
Laboratory LocationKenosha Community Health Center4536 22nd Ave, Kenosha, WI 53140
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 52D2130841

Kenosha Community Health Center · Kenosha, WI
Active · expires May 17, 2027
CLIA Number52D2130841
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateMay 18, 2025
Certificate Expiration DateMay 17, 2027
Laboratory DirectorDr. Timothy Sanborn
Laboratory Phone(262) 771-3500
Laboratory LocationKenosha Community Health Center6226 14th Ave, Kenosha, WI 53140
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CESAR D GONZALEZ DDS
Dentist (Pediatric Dentistry)
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
DIANE E KOSAR
Dental Hygienist
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
DR. HAZEL E MOORE DDS
Dentist (General Practice)
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
DR. MICHAEL MATTHEW MIHAJLOVIC PSYD
Psychologist (Clinical)
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
MANUEL A. RIVERA M.D.
Internal Medicine
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
FAYA KACOS-SHIU LCSW
Social Worker (Clinical)
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
CASSANDRA GILLEN LPC
Counselor (Professional)
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044
MELISSA PESTKA
Nurse Practitioner (Family)
4536 22ND AVE
KENOSHA, WI 53140
Kenosha County (262) 656-0044

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kenosha Community Health Center, Inc.'s NPI number?

The NPI number for Kenosha Community Health Center, Inc. is 1265435960. It was assigned to this organization in the NPPES registry on May 27, 2005.

Where is Kenosha Community Health Center, Inc. located?

Kenosha Community Health Center, Inc. is located at 4536 22nd Ave, Kenosha, WI 53140. The listed phone number is (262) 656-0044.

What is Kenosha Community Health Center, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Kenosha Community Health Center, Inc. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Kenosha Community Health Center, Inc. accept?

Health plans from Anthem Blue Cross and Blue Shield and CareSource (Common Ground Healthcare) list Kenosha Community Health Center, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kenosha Community Health Center, Inc. was last updated on February 25, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.