Healthcare Provider Details

I. General information

NPI: 1710466313
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E DIAMOND AVE STE 100
GAITHERSBURG MD
20877-5321
US

IV. Provider business mailing address

PO BOX 45709
BALTIMORE MD
21297-5709
US

V. Phone/Fax

Practice location:
  • Phone: 301-840-3200
  • Fax:
Mailing address:
  • Phone: 410-382-8111
  • Fax: 443-612-1488

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 TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

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