Provider Demographics
NPI:1528206562
Name:SOUTHFIELD REHABILITION COMPANY
Entity Type:Organization
Organization Name:SOUTHFIELD REHABILITION COMPANY
Other - Org Name:OAKLAND REGIONAL MACOMB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-423-5111
Mailing Address - Street 1:22401 FOSTER WINTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3724
Mailing Address - Country:US
Mailing Address - Phone:248-423-5100
Mailing Address - Fax:248-423-5195
Practice Address - Street 1:11012 E 13 MILE RD
Practice Address - Street 2:SUITE 112A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2572
Practice Address - Country:US
Practice Address - Phone:586-751-9800
Practice Address - Fax:586-751-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI50-6840261QA1903X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E021830OtherBCBS/BCN
MI0P30420Medicare PIN