Healthcare Provider Details

I. General information

NPI: 1639226640
Provider Name (Legal Business Name): MOSAIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 N 11TH ST
GARDEN CITY KS
67846-2714
US

IV. Provider business mailing address

4980 S 118TH ST
OMAHA NE
68137-2220
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-9180
  • Fax: 620-275-2565
Mailing address:
  • Phone: 402-896-3884
  • Fax: 402-894-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateKS

VIII. Authorized Official

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