Healthcare Provider Details

I. General information

NPI: 1538488903
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 N CHARLES ST
BALTIMORE MD
21218-5778
US

IV. Provider business mailing address

849 FAIRMOUNT AVE FL 5
TOWSON MD
21286-2624
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-4360
  • Fax: 410-308-8926
Mailing address:
  • Phone: 410-382-8111
  • Fax: 443-612-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF RICHARDSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-C
Phone: 410-453-9553