Healthcare Provider Details

I. General information

NPI: 1912508144
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 09/14/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NORTH CHARLES ST GIBSON BUILDING ROOM 061
BALTIMORE MD
21204
US

IV. Provider business mailing address

1925 GREENSPRING DR
TIMONIUM MD
21093-4128
US

V. Phone/Fax

Practice location:
  • Phone: 410-453-9553
  • Fax:
Mailing address:
  • Phone: 410-453-9553
  • Fax: 443-612-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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