Provider Demographics
NPI:1104828797
Name:REVERENCE HOME HEALTH & HOSPICE, LLC
Entity Type:Organization
Organization Name:REVERENCE HOME HEALTH & HOSPICE, LLC
Other - Org Name:ASCENSION AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:808 W CEDAR ST BLDG A
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9550
Practice Address - Country:US
Practice Address - Phone:989-310-4003
Practice Address - Fax:844-445-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E139OtherHOMECARE BC/BS
MI381443395014OtherHOMECARE TRICARE
MI237151Medicare Oscar/Certification
23-7151Medicare UPIN
MI1554068Medicaid