Provider Demographics
NPI:1730054149
Name:BESPOKE HAVEN AFH LLC
Entity type:Organization
Organization Name:BESPOKE HAVEN AFH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUGI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-386-1323
Mailing Address - Street 1:5107 26TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3704
Mailing Address - Country:US
Mailing Address - Phone:360-386-1323
Mailing Address - Fax:360-877-4423
Practice Address - Street 1:5107 26TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3704
Practice Address - Country:US
Practice Address - Phone:360-386-1323
Practice Address - Fax:360-877-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty