Provider Demographics
NPI:1497882807
Name:REVERENCE HOME HEALTH AND HOSPICE
Entity Type:Organization
Organization Name:REVERENCE HOME HEALTH AND HOSPICE
Other - Org Name:ASCENSION AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-657-2768
Mailing Address - Street 1:37650 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2055
Mailing Address - Country:US
Mailing Address - Phone:800-248-2298
Mailing Address - Fax:586-723-9455
Practice Address - Street 1:37650 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2055
Practice Address - Country:US
Practice Address - Phone:800-248-2298
Practice Address - Fax:586-723-9455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REVERENCE HOME HEALTH AND HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3481597Medicaid
MI54-0-E0-0701-0OtherBLUE CROSS BLUE SHIELD MI
MI54-0-E0-0701-0OtherBLUE CROSS BLUE SHIELD MI