Healthcare Provider Details

I. General information

NPI: 1134367055
Provider Name (Legal Business Name): SOUTHFIELD REHABILITATION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22401 FOSTER WINTER DRIVE
SOUTHFIELD MI
48075-3724
US

IV. Provider business mailing address

22401 FOSTER WINTER DRIVE
SOUTHFIELD MI
48075-3724
US

V. Phone/Fax

Practice location:
  • Phone: 248-423-5100
  • Fax: 248-423-5195
Mailing address:
  • Phone: 248-423-5100
  • Fax: 248-423-5195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number630013
License Number StateMI

VIII. Authorized Official

Name: DR. EDWARD F. BURKE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 248-423-5111