Organization
TAPESTRY 360 HEALTH
Active
Other names
Tapestry 360 Health - Roosevelt High School, Heartland Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WILLIS (CEO)
(773) 751-7800
Entity
Organization
Contact information
Practice address
3436 WEST WILSON AVENUE, CHICAGO, IL 60625-5318
(773) 866-0818
(773) 866-9069
Mailing address
1301 W DEVON AVE, CHICAGO, IL 60660-1329
(773) 751-7800
(773) 634-7962
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363LC1500X
Community Health Nurse Practitioner
004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004
—
IL
Enumeration date
05/22/2008
Last updated
10/04/2023
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