MEDICARE: BLUE HAVEN HOSPICE, 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	:	1609287895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE HAVEN HOSPICE, LLC

Provider Business Mailing Address
First Line	:	3033 W PRESIDENT GEORGE BUSH HWY STE 150
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-5752
Country	:	US
Telephone Number	:	972-390-7733
Fax Number	:	972-390-7738

Provider Business Practice Location Address
First Line	:	3033 W PRESIDENT GEORGE BUSH HWY STE 150
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-5752
Country	:	US
Telephone Number	:	972-390-7733
Fax Number	:	972-390-7738

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	CASEY ALLEN WILSON
Credential	:
Telephone Number	:	936-856-6888

Provider Enumeration Date	:	05/10/2014
Last Update Date	:	12/22/2025

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