Healthcare Provider Details

I. General information

NPI: 1477722585
Provider Name (Legal Business Name): SOUTHFIELD REHABILITATION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date: 06/04/2008
Reactivation Date: 09/03/2008

III. Provider practice location address

11012 THIRTEEN MILE ROAD SUITE 111
WARREN MI
48093-2546
US

IV. Provider business mailing address

22401 FOSTER WINTER DR
SOUTHFIELD MI
48075-3724
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-8470
  • Fax: 586-558-8481
Mailing address:
  • Phone: 248-423-5100
  • Fax: 248-423-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301046061
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number50C656
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number630013
License Number StateMI

VIII. Authorized Official

Name: RONDA SELEY
Title or Position: MEDICAL STAFF COORDINATOR
Credential:
Phone: 248-423-5198