Basic Information
| Provider Information | |||||||||
| NPI: | 1598882110 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REVERENCE HOME HEALTH & HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASCENSION AT HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5445 ALI DR. | ||||||||
| Address2: | DEPARTMENT 800 | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484395195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882466322 | ||||||||
| FaxNumber: | 8107624110 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 GERMAN ST | ||||||||
| Address2: | |||||||||
| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487639349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893624611 | ||||||||
| FaxNumber: | 9893628771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4086582768 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 353512 | MI | N | Agencies | Hospice Care, Community Based | 251G00000X | N | Agencies | Hospice Care, Community Based | 251G00000X | MI | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 381443395023 | 01 | MI | TRICARE HOSPICE PROVIDER | OTHER | 08737 | 01 | MI | BC BS HOSPICE PROVIDER | OTHER |