MEDICARE: GUEST HOUSE OF MILWAUKEE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	101YM0800X	Mental Health Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	104100000X	Social Worker

General Provider Information

NPI Number	:	1225352768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUEST HOUSE OF MILWAUKEE INC

Provider Business Mailing Address
First Line	:	1216 N 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-2515
Country	:	US
Telephone Number	:	414-345-3240
Fax Number	:	414-345-3248

Provider Business Practice Location Address
First Line	:	1216 N 13TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-2515
Country	:	US
Telephone Number	:	414-345-3240
Fax Number	:	414-345-3258

Authorized Official
Title or Position	:	VP OF CLINIC OPERATIONS
Name	:	KENYATTA MATTHEWS
Credential	:
Telephone Number	:	414-430-0970

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	09/29/2025

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