MEDICARE: HAVEN HOSPICE NM, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1386241057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN HOSPICE NM, LLC

Provider Business Mailing Address
First Line	:	885 PENNIMAN AVE UNIT 6426
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-7722
Country	:	US
Telephone Number	:	888-891-0786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 SILVER HEIGHTS BLVD
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5643
Country	:	US
Telephone Number	:	505-252-5801
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	KRISTI JACKSON
Credential	:
Telephone Number	:	941-257-4285

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	02/26/2024

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