Healthcare Provider Details

I. General information

NPI: 1104828797
Provider Name (Legal Business Name): REVERENCE HOME HEALTH & HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W CEDAR ST BLDG A
STANDISH MI
48658-9550
US

IV. Provider business mailing address

10 CADILLAC DR STE 400
BRENTWOOD TN
37027-1001
US

V. Phone/Fax

Practice location:
  • Phone: 989-310-4003
  • Fax: 844-445-7729
Mailing address:
  • Phone: 615-377-7022
  • Fax: 615-373-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: RUSSELL ADKINS
Title or Position: SVP CHIEF LEGAL OFFICER
Credential:
Phone: 615-926-0340