Healthcare Provider Details

I. General information

NPI: 1811209992
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

IV. Provider business mailing address

PO BOX 45709
BALTIMORE MD
21297-5709
US

V. Phone/Fax

Practice location:
  • Phone: 443-573-8671
  • Fax: 410-243-8175
Mailing address:
  • Phone: 410-453-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUE KESSLER
Title or Position: DIRECTOR, REVENUE CYCLE
Credential:
Phone: 410-382-8111