Provider Demographics
NPI:1699827154
Name:SOUTHERN HILLS HEALTH AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:SOUTHERN HILLS HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:SOUTHERN HILLS NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-277-5724
Mailing Address - Street 1:25500 MEADOWBROOK RD STE 230
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1882
Mailing Address - Country:US
Mailing Address - Phone:248-692-4355
Mailing Address - Fax:248-692-4356
Practice Address - Street 1:19530 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3326
Practice Address - Country:US
Practice Address - Phone:440-816-7500
Practice Address - Fax:440-816-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5140314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2711337Medicaid
OH2711337Medicaid