Healthcare Provider Details

I. General information

NPI: 1144682873
Provider Name (Legal Business Name): MOSAIC GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 PINEVILLE MATTHEWS RD STE S
PINEVILLE NC
28134-8840
US

IV. Provider business mailing address

2810 COLISEUM CENTRE DR STE 520
CHARLOTTE NC
28217-3252
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 980-785-1113
  • Fax: 980-785-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PATRICK MACHOSE
Title or Position: MANAGING MEMBER
Credential: LPA, BCBA
Phone: 980-785-1113