Healthcare Provider Details

I. General information

NPI: 1649310194
Provider Name (Legal Business Name): MOSAIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W CLINTON ST
GOSHEN IN
46526-3216
US

IV. Provider business mailing address

4980 S 118TH ST
OMAHA NE
68137-2200
US

V. Phone/Fax

Practice location:
  • Phone: 574-675-0726
  • Fax: 574-675-0847
Mailing address:
  • Phone: 402-896-3884
  • Fax: 402-894-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT HOFFMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 402-896-3884