1730337601 NPI number — SOUTHFIELD REHABILITATION COMPANY

Table of content: (NPI 1730337601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730337601 NPI number — SOUTHFIELD REHABILITATION COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHFIELD REHABILITATION 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 HOSPITAL
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:
1730337601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 674073
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-582-0864
Provider Business Mailing Address Fax Number:
586-576-0393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22401 FOSTER WINTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-423-5100
Provider Business Practice Location Address Fax Number:
248-423-5199
Provider Enumeration Date:
09/04/2008

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:
586-751-3380

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  630013 , 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: 00127 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 302837175 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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