1477722585 NPI number — SOUTHFIELD REHABILITATION COMPANY

Table of content: (NPI 1477722585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477722585 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:
Provider Other Organization Name Type Code:
6
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:
1477722585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/04/2008
NPI Reactivation Date:
09/03/2008

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:
48267-4073
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:
11012 THIRTEEN MILE ROAD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-558-8470
Provider Business Practice Location Address Fax Number:
586-558-8481
Provider Enumeration Date:
02/22/2008

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:
248-423-5111

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  4301046061 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0208X , with the licence number: 50C656 , 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: 630013 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 283723740 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 40003 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700E021910 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 135598501 . This is a "U.S. DEPARTMENT OF LABOR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 032307 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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