Provider Demographics
NPI:1861034142
Name:TAPESTRY WICKLIFFE SENIOR HOUSING MANAGEMENT, LLC
Entity Type:Organization
Organization Name:TAPESTRY WICKLIFFE SENIOR HOUSING MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-854-8800
Mailing Address - Street 1:2001 KILLEBREW DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1884
Mailing Address - Country:US
Mailing Address - Phone:952-854-8800
Mailing Address - Fax:
Practice Address - Street 1:28500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2500
Practice Address - Country:US
Practice Address - Phone:440-373-9900
Practice Address - Fax:440-943-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility