Healthcare Provider Details

I. General information

NPI: 1437720976
Provider Name (Legal Business Name): MATT TALBOT RECOVERY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N 32ND ST
MILWAUKEE WI
53210-1915
US

IV. Provider business mailing address

2835 N 32ND ST
MILWAUKEE WI
53210-1915
US

V. Phone/Fax

Practice location:
  • Phone: 414-939-7145
  • Fax:
Mailing address:
  • Phone: 414-939-7145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: KARL RAJANI
Title or Position: CEO
Credential:
Phone: 414-301-6381