Provider Demographics
NPI:1386625143
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:DR
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:248-423-5111
Mailing Address - Street 1:PO BOX 674073
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4073
Mailing Address - Country:US
Mailing Address - Phone:586-582-0864
Mailing Address - Fax:586-576-0393
Practice Address - Street 1:22401 FOSTER WINTER DRIVE
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:248-423-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2011-01-26
Deactivation Date:2008-06-04
Deactivation Code:
Reactivation Date:2008-07-15
Provider Licenses
StateLicense IDTaxonomies
MI634550314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI135598503OtherU.S. DEPARTMENT OF LABOR
MI027879OtherMIDWEST HEALTH PLAN
MI09560OtherBLUE CROSS BLUE SHIELD
MI602897979Medicaid
MI289797960Medicaid
MI6330390OtherAETNA
MI1031384OtherMCLAREN HEALTH PLAN
MI34692OtherHEALTH PLAN OF MICHIGAN
MI289797960Medicaid