Healthcare Provider Details

I. General information

NPI: 1386867901
Provider Name (Legal Business Name): MOSAIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S 12TH ST
BEATRICE NE
68310-4548
US

IV. Provider business mailing address

4980 S 118TH ST
OMAHA NE
68137-2220
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-4066
  • Fax: 402-223-4951
Mailing address:
  • Phone: 402-896-3884
  • Fax: 402-894-4780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT HOFFMAN
Title or Position: SVP CHIEF FINANCIAL OFFICER
Credential:
Phone: 402-896-3884