MEDICARE: MOSAIC CHILDHOOD PROJECT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1508041542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC CHILDHOOD PROJECT, INC.

Provider Business Mailing Address
First Line	:	1333 W NORTH SHORE AVE
Second Line	:	3N
City	:	CHICAGO
State	:	IL
Zip	:	60626-4767
Country	:	US
Telephone Number	:	773-575-6215
Fax Number	:	773-341-7376

Provider Business Practice Location Address
First Line	:	1333 W NORTH SHORE AVE
Second Line	:	3N
City	:	CHICAGO
State	:	IL
Zip	:	60626-4767
Country	:	US
Telephone Number	:	773-575-6215
Fax Number	:	773-341-7376

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JESSICA L MCCARTHY
Credential	:	MS CCC/SLP
Telephone Number	:	773-575-6215

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	01/09/2008

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