Organization
MATT TALBOT RECOVERY SERVICES, INC
Active
Other names
Samson House
Organization subpart
No
Provider details
NPI number
Authorized official
KARL RAJANI (CEO)
(414) 301-6381
Entity
Organization
Contact information
Practice address
611 N GRAND AVE, WAUKESHA, WI 53186-4918
(414) 939-7145
(414) 321-5935
Mailing address
2819 W HIGHLAND BLVD, MILWAUKEE, WI 53208-3217
(414) 939-7145
(414) 321-5935
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/11/2021
Last updated
01/11/2021
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