Provider Demographics
NPI:1295772184
Name:REVERENCE HOME HEALTH & HOSPICE, LLC
Entity type:Organization
Organization Name:REVERENCE HOME HEALTH & HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:615-373-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:28120 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5603
Practice Address - Country:US
Practice Address - Phone:888-246-6322
Practice Address - Fax:810-762-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
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
MIOE105OtherBLUE CROSS
MIOE105OtherBLUE CROSS
MI3525655Medicaid