NPIMap

Organization Active NPI

Matt Talbot Recovery Services, Inc.

  • Substance Abuse Rehabilitation Facility
  • Milwaukee, WI
National Provider Identifier
1174992895
Registry record updated Sep 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MATT TALBOT RECOVERY SERVICES, INC.
Practice address
2613 W North Ave
Milwaukee, WI 53205-1056
Phone
(414) 342-5474
Fax
(414) 342-5476
NPI assigned
Sep 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Antoneo Deshazor
Title
Executive Director
Phone
(414) 793-3896

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

2613 W North Ave
Milwaukee, WI 53205-1056

Mailing address

2613 W North Ave
Milwaukee, WI 53205-1056
Phone (414) 342-5474

National Provider Directory

National Provider Directory
Tax ID family
Matt Talbot Recovery Services Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2613 W North Ave
Milwaukee, WI 53205
Phone (414) 342-5474

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1174992895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2613 W NORTH AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532051056",
            "telephone_number": "414-342-5474",
            "fax_number": "414-342-5476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2613 W NORTH AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532051056",
            "telephone_number": "414-342-5474",
            "fax_number": "414-342-5476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATT TALBOT RECOVERY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "DESHAZOR",
        "authorized_official_first_name": "ANTONEO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "414-793-3896"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.