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General NPI Number Information
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NPI Number | 1861354607
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Entity Type | Organization
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Legal Business Name | MAT RECOVERY CENTERS LLC
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 3598 CANYON PARK RD
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City | DODGEVILLE
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State | WI
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Zip | 53533-9066
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Country | US
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Telephone | 708-204-8602
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Fax | 708-204-8602
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Provider Business Mailing Address
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Address Line | 3598 CANYON PARK RD
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City | DODGEVILLE
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State | WI
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Zip | 53533-9066
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Country | US
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Telephone | 708-204-8602
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Fax | 708-204-8602
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Authorized Official
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Title or Position | CEO
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Name | ED LETOURNEAU
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Credential |
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Telephone | 708-204-8602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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