Provider Demographics
NPI:1558652925
Name:TAPESTRY
Entity Type:Organization
Organization Name:TAPESTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMBENGER
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:651-489-7740
Mailing Address - Street 1:135 COLORADO ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-2244
Mailing Address - Country:US
Mailing Address - Phone:651-454-2323
Mailing Address - Fax:
Practice Address - Street 1:135 COLORADO ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-2244
Practice Address - Country:US
Practice Address - Phone:651-454-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3017673245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children