Provider Demographics
NPI:1356054019
Name:BESPOKE TREATMENT LLC
Entity type:Organization
Organization Name:BESPOKE TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:THI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-205-8232
Mailing Address - Street 1:12381 WILSHIRE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1063
Mailing Address - Country:US
Mailing Address - Phone:833-867-2329
Mailing Address - Fax:833-867-3757
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 38
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1934
Practice Address - Country:US
Practice Address - Phone:833-867-2329
Practice Address - Fax:833-867-3757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BESPOKE TREATMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health