Healthcare Provider Details

I. General information

NPI: 1003076258
Provider Name (Legal Business Name): MOSAIC COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 E GREEN ST BLDG AB
WESTMINSTER MD
21157-5410
US

IV. Provider business mailing address

PO BOX 45709
BALTIMORE MD
21297-5709
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-3007
  • Fax: 410-751-7797
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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