NPIMap

Organization Active NPI

Tapestry 360 Health

Doing business as Heartland Health Centers

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
National Provider Identifier
1700044039
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TAPESTRY 360 HEALTH
Doing business as
Heartland Health Centers
Practice address
3436 West Wilson Avenue
Chicago, IL 60625-5318
Phone
(773) 866-0818
Fax
(773) 866-9069
NPI assigned
May 22, 2008
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Willis
Title
Ceo
Phone
(773) 751-7800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Community Health Nurse Practitioner 363LC1500X 004 IL

Addresses

Primary practice location

3436 West Wilson Avenue
Chicago, IL 60625-5318

Mailing address

1301 W Devon Ave
Chicago, IL 60660-1329
Phone (773) 751-7800

Other identifiers 1

IdentifierTypeStateIssuer
004MedicaidIL

Other names 2

  • Heartland Health Centers Doing business as
  • Tapestry 360 Health - Roosevelt High School Other name

National Provider Directory

National Provider Directory
Tax ID family
Heartland Health Centers24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1700044039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601329",
            "telephone_number": "773-751-7800",
            "fax_number": "773-634-7962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3436 WEST WILSON AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255318",
            "telephone_number": "773-866-0818",
            "fax_number": "773-866-9069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAPESTRY 360 HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-751-7800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "IL",
            "license": "004",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartland Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tapestry 360 Health - Roosevelt High School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.