Healthcare Provider Details

I. General information

NPI: 1205594546
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 MELLOR AVE
CATONSVILLE MD
21228-5106
US

IV. Provider business mailing address

849 FAIRMOUNT AVE FL 5
TOWSON MD
21286-2624
US

V. Phone/Fax

Practice location:
  • Phone: 410-453-9553
  • Fax: 443-612-1488
Mailing address:
  • Phone: 410-382-8111
  • Fax: 443-612-1488

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: JEFFREY RICHARDSON
Title or Position: VP & COO COMMUNITY SERVICES
Credential:
Phone: 410-453-9553