Healthcare Provider Details

I. General information

NPI: 1386625143
Provider Name (Legal Business Name): SOUTHFIELD REHABILITATION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date: 06/04/2008
Reactivation Date: 07/15/2008

III. Provider practice location address

22401 FOSTER WINTER DRIVE
SOUTHFIELD MI
48075-3724
US

IV. Provider business mailing address

PO BOX 674073
DETROIT MI
48267-4073
US

V. Phone/Fax

Practice location:
  • Phone: 248-423-5100
  • Fax: 248-423-5195
Mailing address:
  • Phone: 586-582-0864
  • Fax: 586-576-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number634550
License Number StateMI

VIII. Authorized Official

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