Healthcare Provider Details

I. General information

NPI: 1689468712
Provider Name (Legal Business Name): MOSAIC SOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 ELMWOOD ST NE
GRAND RAPIDS MI
49505-4737
US

IV. Provider business mailing address

242 ELMWOOD ST NE
GRAND RAPIDS MI
49505-4737
US

V. Phone/Fax

Practice location:
  • Phone: 616-821-5840
  • Fax:
Mailing address:
  • Phone: 616-821-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BERNES
Title or Position: OWNER
Credential:
Phone: 616-821-5840