{
"Npi": {
"NPI": "1780718189",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MERIDIAN BEHAVIORAL HEALTH",
"ParentOrgTIN": null,
"OrgName": "TAPESTRY TREATMENT CENTER LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "550 MAIN STREET",
"SecondLineMailingAddress": "SUITE 230",
"MailingAddressCityName": "NEW BRIGHTON",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55112",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "612-326-7600",
"MailingAddressFaxNumber": "651-631-3231",
"FirstLinePracticeLocationAddress": "135 COLORADO STREET EAST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ST PAUL",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55107",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-489-7740",
"PracticeLocationAddressFaxNumber": "651-489-6458",
"EnumerationDate": "03/15/2007",
"LastUpdateDate": "02/20/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ZEIDNER",
"AuthorizedOfficialFirstName": "LEWIS",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHD",
"AuthorizedOfficialTelephoneNumber": "763-245-8278",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "830536-4-CDT",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "802564-2-CDT",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "830536",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "324500000X",
"TaxonomyName": "Substance Abuse Rehabilitation Facility",
"LicenseNumber": "830536-5-CDT",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}