Provider Demographics
NPI:1437720976
Name:MATT TALBOT RECOVERY SERVICES, INC
Entity Type:Organization
Organization Name:MATT TALBOT RECOVERY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-301-6381
Mailing Address - Street 1:2835 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1915
Mailing Address - Country:US
Mailing Address - Phone:414-939-7145
Mailing Address - Fax:
Practice Address - Street 1:2835 N 32ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1915
Practice Address - Country:US
Practice Address - Phone:414-939-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit