Provider Demographics
NPI:1891919445
Name:TAPESTRY SENIOR LIVING OF MARION, LLC
Entity type:Organization
Organization Name:TAPESTRY SENIOR LIVING OF MARION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS & HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-377-9808
Mailing Address - Street 1:365 MARION BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3139
Mailing Address - Country:US
Mailing Address - Phone:319-377-9808
Mailing Address - Fax:319-377-9821
Practice Address - Street 1:365 MARION BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3139
Practice Address - Country:US
Practice Address - Phone:319-377-9808
Practice Address - Fax:319-377-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0026310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2554004HMedicaid
IA2441961DMedicaid