Provider Demographics
NPI:1730337601
Name:SOUTHFIELD REHABILITATION COMPANY
Entity type:Organization
Organization Name:SOUTHFIELD REHABILITATION COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-751-3380
Mailing Address - Street 1:PO BOX 674073
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:586-582-0864
Mailing Address - Fax:586-576-0393
Practice Address - Street 1:22401 FOSTER WINTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3724
Practice Address - Country:US
Practice Address - Phone:248-423-5100
Practice Address - Fax:248-423-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630013273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00127OtherBLUE CROSS BLUE SHIELD
MI302837175Medicaid
MI23T301Medicare Oscar/Certification