MATT TALBOT RECOVERY SERVICES, INC. (NPI# 1174992895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174992895 |
| Entity Type | Organization |
| Organization Name | MATT TALBOT RECOVERY SERVICES, INC. |
| Practice Address |
2613 W North Ave Milwaukee WI 53205-1056 |
| Practice Telephone | 4143425474 |
| Practice Fax Number | 4143425476 |
| Mailing Telephone | 4143425474 |
| Mailing Fax Number | 4143425476 |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |
| Authorized Official Name | ANTONEO DESHAZOR (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4147933896 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Street Address |
2613 W NORTH AVE |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53205-1056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467931691 | The Salvation Army - Wisconsin and Upper Michigan | Counselor | 1730 N 7th Street, Milwaukee, WI 53205 | 2018-08-08 |
| 1821596909 | Robert Leland Goodman | Counselor | 1134 W. North Ave, Second Floor, Milwaukee, WI 53205 | 2018-01-24 |
| 1265980767 | Wisconsin Healthcare Services | Clinic/Center | 2462 West Lisbon Avenue, Milwaukee, WI 53205 | 2016-09-14 |
| 1841667466 | St. Ann Center for Intergenerational Care | Public Health or Welfare | 2450 W North Ave, Milwaukee, WI 53205 | 2015-08-31 |
| 1407252646 | Abdelrahman H. Alarga | Pharmacist | 1919 W North Ave., Milwaukee, WI 53205 | 2014-11-17 |
| 1679981328 | Life Changing Ministries Substance Abuse Services | Clinic/Center | 1134 W North Ave 2nd Floor, Milwaukee, WI 53205 | 2014-07-25 |
| 1891031969 | Robin Michelle Benjamin | Licensed Practical Nurse | 1536 N 20th, Mil., WI 53205 | 2012-12-18 |
| 1275712937 | Bruce G Hartwell | Dentist | 901 W Winnebago St, Suite Ll-01, Milwaukee, WI 53205 | 2007-10-30 |
| 1407978521 | Westside Healthcare Association, Inc | Clinic/Center | 1452 N. 7th Street, Milwaukee, WI 53205 | 2007-04-06 |
| 1740316181 | Neville Winston Duncan | Family Medicine | 1134 W North Ave Fl 2, Milwaukee, WI 53205 | 2007-02-27 |
| Find all providers in zip 53205 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740589084 | Harambee Ombudsman Project Inc. | Substance Abuse Rehabilitation Facility | 335 W Wright St, Milwaukee, WI 53212-2729 | 2011-03-25 |
| 1790088896 | Meta House | Substance Abuse Rehabilitation Facility | 2618 N Bremen St, Milwaukee, WI 53212-3003 | 2010-12-10 |
| 1821326455 | Whites Residential Treatment & Clinical Services, Inc. | Substance Abuse Rehabilitation Facility | 4020 W Burleigh St, Milwaukee, WI 53210-1817 | 2009-11-19 |
| 1467609776 | United Community Center | Substance Abuse Rehabilitation Facility | 1111 S 6th St, Milwaukee, WI 53204-2301 | 2008-08-19 |
| 1639244254 | Horizon Inc | Substance Abuse Rehabilitation Facility | 2511 West Vine Street, Milwaukee, WI 53205 | 2006-11-21 |
| 1285187179 | River's Shore Clinic Ctc | Substance Abuse Rehabilitation Facility | 3707 N Richards St, Milwaukee, WI 53212-1673 | 2016-07-27 |
| 1124482229 | Shecar Substance Abuse/mental Health Clinic | Substance Abuse Rehabilitation Facility | 2821 N 4th St, Milwaukee, WI 53212-2362 | 2016-04-05 |
| 1003217423 | Kenneth Santana | Substance Abuse Rehabilitation Facility | 1111 S 6th St, Milwaukee, WI 53204-2301 | 2014-09-05 |
| 1063759306 | United Community Center | Substance Abuse Rehabilitation Facility | 1028 S 9th St, Milwaukee, WI 53204-1335 | 2013-01-07 |
| 1386943066 | Community Care Housing LLC | Substance Abuse Rehabilitation Facility | 544 E Ogden Ave, Ste 700-268, Milwaukee, WI 53202-2698 | 2011-03-21 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.