Provider Demographics
NPI:1174373617
Name:TAPESTRY MOON, LLC
Entity type:Organization
Organization Name:TAPESTRY MOON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER, PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-398-9972
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:952-854-4434
Practice Address - Street 1:550 CHERRINGTON PKWY
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4302
Practice Address - Country:US
Practice Address - Phone:412-507-9999
Practice Address - Fax:412-595-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility