Provider Demographics
NPI:1780718189
Name:TAPESTRY TREATMENT CENTER LLC
Entity type:Organization
Organization Name:TAPESTRY TREATMENT CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-245-8278
Mailing Address - Street 1:550 MAIN STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:651-631-3231
Practice Address - Street 1:135 COLORADO STREET EAST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107
Practice Address - Country:US
Practice Address - Phone:651-489-7740
Practice Address - Fax:651-489-6458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERIDIAN BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN830536-4-CDT324500000X
MN802564-2-CDT324500000X
MN830536324500000X
MN830536-5-CDT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility