Provider Demographics
NPI:1598882110
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 1:716 GERMAN ST
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9349
Practice Address - Country:US
Practice Address - Phone:989-362-4611
Practice Address - Fax:989-362-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI353512251G00000X
251G00000X
MI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381443395023OtherTRICARE HOSPICE PROVIDER
MI08737OtherBC BS HOSPICE PROVIDER
MI08737OtherBC BS HOSPICE PROVIDER
MI2720637Medicaid