NPI 1174992895

Matt Talbot Recovery Services, INC.

Organisation Substance Abuse Rehabilitation Facility Milwaukee, WI

Practice location

Address: 2613 W North Ave, Milwaukee, WI 53205-1056
Phone: (414) 342-5474
Fax: (414) 342-5476

Authorised official

Name: Antoneo Deshazor
Title: Executive Director
Phone: (414) 793-3896

Registered specialties (2)

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X

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Community/Behavioral Health Agency

Agencies Taxonomy 251S00000X

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Registry record

NPI: 1174992895
Entity type: Organization
NPI issued: 23 Sep 2015
Record last updated: 23 Sep 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.