Healthcare Provider Details

I. General information

NPI: 1043911795
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 GREENSPRING DR
TIMONIUM MD
21093-4128
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:
Mailing address:
  • Phone: 410-382-8111
  • Fax: 443-612-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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