Provider Demographics
NPI:1225352768
Name:GUEST HOUSE OF MILWAUKEE INC
Entity type:Organization
Organization Name:GUEST HOUSE OF MILWAUKEE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KENYATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-345-3240
Mailing Address - Street 1:1216 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2515
Mailing Address - Country:US
Mailing Address - Phone:414-345-3240
Mailing Address - Fax:414-345-3258
Practice Address - Street 1:1216 N 13TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2515
Practice Address - Country:US
Practice Address - Phone:414-345-3240
Practice Address - Fax:414-345-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 101YA0400X, 101YM0800X, 207R00000X, 104100000X
WI284-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty