Organization
MATT TALBOT RECOVERY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONEO DESHAZOR (EXECUTIVE DIRECTOR)
(414) 793-3896
Entity
Organization
Contact information
Practice address
2613 W NORTH AVE, MILWAUKEE, WI 53205-1056
(414) 342-5474
(414) 342-5476
Mailing address
2613 W NORTH AVE, MILWAUKEE, WI 53205-1056
(414) 342-5474
(414) 342-5476
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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