Provider Demographics
NPI:1841345634
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:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-658-2768
Mailing Address - Street 1:5445 ALI DR.
Mailing Address - Street 2:DEPARTMENT 800
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5195
Mailing Address - Country:US
Mailing Address - Phone:888-246-6322
Mailing Address - Fax:810-762-4110
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:48439-5195
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:2007-01-24
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI254028251G00000X
MI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E04600MOtherHPL
MI382177968OtherPPOM (HSP)
HH250001OtherMCARE
MI38217768OtherPRIVATE INSURANCES
08711OtherBCBSM
MI382177968OtherPPOM (HSP)
HH250001OtherMCARE