MEDICARE: REVERENCE HOME HEALTH & HOSPICE, LLC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	353512	MI
2	251G00000X	Community Based Hospice Care Agency
3	251G00000X	Community Based Hospice Care Agency		MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	381443395023	OTHER	MI	TRICARE HOSPICE PROVIDER
2	08737	OTHER	MI	BC BS HOSPICE PROVIDER

NPI Number	:	1598882110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVERENCE HOME HEALTH & HOSPICE, LLC

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

Provider Business Practice Location Address
First Line	:	716 GERMAN ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9349
Country	:	US
Telephone Number	:	989-362-4611
Fax Number	:	989-362-8771

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/29/2019

716 GERMAN ST
TAWAS CITY, MI
48763-9349

Practice Phone: 989-362-4611
Practice Fax: 989-362-8771

700 GERMAN ST
TAWAS CITY, MI
48763-9349