1710097977 NPI number — REVERENCE HOME HEALTH & HOSPICE, LLC

Table of content: (NPI 1710097977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710097977 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:
1710097977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CADILLAC DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-377-7022
Provider Business Mailing Address Fax Number:
615-373-4457

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:
48439-5177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-603-8600
Provider Business Practice Location Address Fax Number:
810-762-4110
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADKINS
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP CHIEF LEGAL OFFICER
Authorized Official Telephone Number:
615-309-5668

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , 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: 382177968 . This is a "COMMERICAL INS (H/C)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 382177968050 . This is a "COMM CHOICE (ISS/MSS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 382177968 . This is a "PPOM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 15-5173480 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 382177968 . This is a "PRIVATE INSURANCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 382177968000 . This is a "COMMUNITY CHOICE (H/C)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77-2940185 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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