Organization
TAPESTRY 360 HEALTH
Active
Other names
Tapestry 360 Health - Senn 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
5900 N GLENWOOD AVE, CHICAGO, IL 60660-3312
(773) 751-1860
(773) 989-8345
Mailing address
1301 W DEVON AVE, CHICAGO, IL 60660-1329
(773) 751-7800
(773) 437-8004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
113310
IL
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113310
DORAL DENTAL
IL
Enumeration date
05/21/2008
Last updated
10/04/2023
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