Basic Information
| Provider Information | |||||||||
| NPI: | 1780718189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAPESTRY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 MAIN STREET | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123267600 | ||||||||
| FaxNumber: | 6516313231 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 COLORADO STREET EAST | ||||||||
| Address2: | |||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514897740 | ||||||||
| FaxNumber: | 6514896458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | LINDEMAN | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR - REVENUE CYCLE MGMT | ||||||||
| AuthorizedOfficialTelephone: | 6123267566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MERIDIAN BEHAVIORAL HEALTH | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 830536 | MN | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | 830536-4-CDT | MN | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | 802564-2-CDT | MN | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 324500000X | 830536-5-CDT | MN | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.