Healthcare Provider Details

I. General information

NPI: 1487952297
Provider Name (Legal Business Name): MOSAIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W PARK AVE
NORFOLK NE
68701-4701
US

IV. Provider business mailing address

4980 S 118TH ST
OMAHA NE
68137-2200
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-3888
  • Fax:
Mailing address:
  • Phone: 402-896-3884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities 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