Provider Demographics
NPI:1215670096
Name:BESPOKE HOSPICE CARE LLC
Entity type:Organization
Organization Name:BESPOKE HOSPICE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:MCKIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-507-6751
Mailing Address - Street 1:9001 AIRPORT FWY STE 580
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7774
Mailing Address - Country:US
Mailing Address - Phone:214-957-9899
Mailing Address - Fax:
Practice Address - Street 1:9001 AIRPORT FWY STE 580
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7774
Practice Address - Country:US
Practice Address - Phone:214-957-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based