Basic Information
Provider Information | |||||||||
NPI: | 1841345634 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REVERENCE HOME HEALTH & HOSPICE, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ASCENSION AT HOME | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 5445 ALI DR. | ||||||||
Address2: | DEPARTMENT 800 | ||||||||
City: | GRAND BLANC | ||||||||
State: | MI | ||||||||
PostalCode: | 484395195 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8882466322 | ||||||||
FaxNumber: | 8107624110 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2007 | ||||||||
LastUpdateDate: | 07/29/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCOTT | ||||||||
AuthorizedOfficialFirstName: | STEVEN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
AuthorizedOfficialTelephone: | 4086582768 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 254028 | MI | N |   | Agencies | Hospice Care, Community Based |   | 251G00000X |   | MI | Y |   | Agencies | Hospice Care, Community Based |   |
ID Information
ID | Type | State | Issuer | Description | 0E04600M | 01 |   | HPL | OTHER | 382177968 | 01 | MI | PPOM (HSP) | OTHER | HH250001 | 01 |   | MCARE | OTHER | 38217768 | 01 | MI | PRIVATE INSURANCES | OTHER | 08711 | 01 |   | BCBSM | OTHER |