Healthcare Provider Details

I. General information

NPI: 1013661958
Provider Name (Legal Business Name): REVERENCE HOME HEALTH & HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28120 DEQUINDRE RD
WARREN MI
48092-5603
US

IV. Provider business mailing address

10 CADILLAC DR STE 400
BRENTWOOD TN
37027-1001
US

V. Phone/Fax

Practice location:
  • Phone: 586-913-0333
  • Fax: 586-263-3306
Mailing address:
  • Phone: 417-841-4834
  • Fax: 866-955-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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