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General NPI Number Information
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NPI Number | 1386625143
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Entity Type | Organization
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Legal Business Name | SOUTHFIELD REHABILITATION COMPANY
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 22401 FOSTER WINTER DRIVE
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3724
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Country | US
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Telephone | 248-423-5100
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Fax | 248-423-5195
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Provider Business Mailing Address
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Address Line | PO BOX 674073
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City | DETROIT
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State | MI
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Zip | 48267-4073
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Country | US
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Telephone | 586-582-0864
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Fax | 586-576-0393
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD F. BURKE
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Credential | D.O.
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Telephone | 248-423-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 634550
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License Number State | MI
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