MEDICARE: BLUE OCEAN HOME HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1316871478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE OCEAN HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1509 TENACITY DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0209
Country	:	US
Telephone Number	:	945-998-2239
Fax Number	:	945-998-2239

Provider Business Practice Location Address
First Line	:	1509 TENACITY DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-0209
Country	:	US
Telephone Number	:	945-998-2239
Fax Number	:	945-998-2239

Authorized Official
Title or Position	:	OWNER
Name	:	HILARY TABONG
Credential	:
Telephone Number	:	945-998-2239

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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