Healthcare Provider Details

I. General information

NPI: 1689742439
Provider Name (Legal Business Name): MOSAIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CHAPMAN RD STE 201
NEWARK DE
19702-5428
US

IV. Provider business mailing address

4980 S 118TH ST
OMAHA NE
68137-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-456-5995
  • Fax: 302-456-5998
Mailing address:
  • Phone: 402-896-3884
  • Fax: 402-896-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT O HOFFMAN
Title or Position: SVP OF FINANCE
Credential:
Phone: 402-896-3884