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	276400000X	Substance Use Disorder Rehabilitation Hospital Unit

General Provider Information

NPI Number	:	1437720976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATT TALBOT RECOVERY SERVICES, INC

Provider Business Mailing Address
First Line	:	2835 N 32ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1915
Country	:	US
Telephone Number	:	414-939-7145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2835 N 32ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1915
Country	:	US
Telephone Number	:	414-939-7145
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KARL RAJANI
Credential	:
Telephone Number	:	414-301-6381

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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