MEDICARE: MATT TALBOT RECOVERY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1174992895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATT TALBOT RECOVERY SERVICES, INC.

Provider Business Mailing Address
First Line	:	2613 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1056
Country	:	US
Telephone Number	:	414-342-5474
Fax Number	:	414-342-5476

Provider Business Practice Location Address
First Line	:	2613 W NORTH AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1056
Country	:	US
Telephone Number	:	414-342-5474
Fax Number	:	414-342-5476

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANTONEO DESHAZOR
Credential	:
Telephone Number	:	414-793-3896

Provider Enumeration Date	:	09/23/2015
Last Update Date	:	09/23/2015

Similar Medicare Providers

1134589187 — MEGAN LARSCHEID SKAGGS LCSW
Practice Location Address:

2610 W NORTH AVE
MILWAUKEE, WI
53205-1026

Practice Phone: 414-840-3503
Practice Fax:

1245172030 — ALETHEA ALLEN
Practice Location Address:

2028 N 16TH ST
MILWAUKEE, WI
53205-1213

Practice Phone: 608-319-5298
Practice Fax:

1083556781 — ALISA ANN CRAWLEY
Practice Location Address:

1228 W LLOYD ST
MILWAUKEE, WI
53205-1243

Practice Phone: 414-264-6000
Practice Fax:

1023951480 — MIANGEL LISTER
Practice Location Address:

2217 N 15TH ST
MILWAUKEE, WI
53205-1212

Practice Phone: 414-204-5447
Practice Fax:

1265427322 — MS. PATRICE ANN BARTELME MS, FNP
Practice Location Address:

1730 N 7TH ST
MILWAUKEE, WI
53205-1701

Practice Phone: 414-265-6360
Practice Fax: 414-265-8151

1942296215 — MS. SARAH PACKMAN APNP
Practice Location Address:

1702 W WALNUT ST
MILWAUKEE, WI
53205-1616

Practice Phone: 414-933-1300
Practice Fax:

Directions to “MATT TALBOT RECOVERY SERVICES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.