Provider Demographics
NPI:1790785095
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:RONDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SELEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-423-5198
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:248-423-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XS0106X, 207XX0005X, 2082S0105X, 2084N0400X, 2085R0202X, 2471C3401X, 261QR0208X, 282N00000X, 367500000X
MI630013261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00127OtherBCBS OF MICHIGAN
MI007389OtherMIDWEST HEALTH PLAN
135598501OtherU.S. DEPARTMENT OF LABOR
MI34692OtherHEALTH PLAN OF MICHIGAN
MI00127OtherBLUE CARE NETWORK
MI30 2837175Medicaid
MI40 2837237Medicaid
MI1031384OtherMCLAREN HEALTH PLAN
MI5968608OtherAETNA
MI40 2837237Medicaid
0P30420Medicare Oscar/Certification