Provider Demographics
NPI:1710097977
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 1:5445 ALI DR.
Practice Address - Street 2:DEPARTMENT 800
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5177
Practice Address - Country:US
Practice Address - Phone:810-603-8600
Practice Address - Fax:810-762-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
382177968OtherCOMMERICAL INS (H/C)
382177968050OtherCOMM CHOICE (ISS/MSS)
MI382177968OtherPPOM
MI15-5173480Medicaid
382177968OtherPRIVATE INSURANCES
382177968000OtherCOMMUNITY CHOICE (H/C)
MI77-2940185Medicaid
382177968OtherCOMMERICAL INS (H/C)
382177968000OtherCOMMUNITY CHOICE (H/C)
MI77-2940185Medicaid
MI15-5173480Medicaid
382177968050OtherCOMM CHOICE (ISS/MSS)
0E046Medicare UPIN
MI15-5173480Medicaid