Healthcare Provider Details

I. General information

NPI: 1053533216
Provider Name (Legal Business Name): SOUTH FIELD REHABILTATION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/28/2011
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

255 WEST MICHIGAN AVENUE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 248-423-5100
  • Fax: 248-423-5195
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL R. BABB
Title or Position: CEO
Credential:
Phone: 248-423-5111