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NPI Code Detail

MEDICARE: TAPESTRY 360 HEALTH

MEDICARE: TAPESTRY 360 HEALTH
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1609289883
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAPESTRY 360 HEALTH
Provider Business Mailing Address
First Line : 1301 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1329
Country : US
Telephone Number : 773-751-7800
Fax Number : 773-437-8004
Provider Business Practice Location Address
First Line : 1300 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60660-1302
Country : US
Telephone Number : 773-296-7544
Fax Number : 773-296-7637
Authorized Official
Title or Position : CEO
Name : NICOLE WILLIS
Credential :
Telephone Number : 773-751-7800
Provider Enumeration Date : 06/05/2014
Last Update Date : 10/03/2023

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Directions to “TAPESTRY 360 HEALTH ” Practice Location

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