Healthcare Provider Details

I. General information

NPI: 1932386257
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WINTERS LN
CATONSVILLE MD
21228-4432
US

IV. Provider business mailing address

849 FAIRMOUNT AVE FL 5
TOWSON MD
21286-2624
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-4492
  • Fax:
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: JEFFREY RICHARDSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW-C
Phone: 410-453-9553