1841345634 NPI number — REVERENCE HOME HEALTH & HOSPICE, LLC

Table of content: PATRICIA BROSCHART VALENZA PT (NPI 1457824005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841345634 NPI number — REVERENCE HOME HEALTH & HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REVERENCE HOME HEALTH & HOSPICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841345634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5445 ALI DR.
Provider Second Line Business Mailing Address:
DEPARTMENT 800
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-5195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-246-6322
Provider Business Mailing Address Fax Number:
810-762-4110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5445 ALI DR.
Provider Second Line Business Practice Location Address:
DEPARTMENT 800
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-5195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-246-6322
Provider Business Practice Location Address Fax Number:
810-762-4110
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP REVENUE CYCLE
Authorized Official Telephone Number:
408-658-2768

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  254028 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0E04600M . This is a "HPL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 382177968 . This is a "PPOM (HSP)" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: HH250001 . This is a "MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 38217768 . This is a "PRIVATE INSURANCES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 08711 . This is a "BCBSM" identifier . This identifiers is of the category "OTHER".




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