1528206562 NPI number — SOUTHFIELD REHABILITION COMPANY

Table of content: (NPI 1528206562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528206562 NPI number — SOUTHFIELD REHABILITION COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHFIELD REHABILITION COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OAKLAND REGIONAL MACOMB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528206562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22401 FOSTER WINTER DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-423-5100
Provider Business Mailing Address Fax Number:
248-423-5195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11012 E 13 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 112A
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-2572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-751-9800
Provider Business Practice Location Address Fax Number:
586-751-9818
Provider Enumeration Date:
01/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BURKE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-423-5111

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  50-6840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 50-6840 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 700E021830 . This is a "BCBS/BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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