Healthcare Provider Details

I. General information

NPI: 1578093928
Provider Name (Legal Business Name): TAPESTRY FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 E GOBBI ST STE B
UKIAH CA
95482-5511
US

IV. Provider business mailing address

290 E GOBBI ST
UKIAH CA
95482-5559
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-6453
  • Fax:
Mailing address:
  • Phone: 707-463-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JOHNS
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 707-463-3300