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General NPI Number Information
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NPI Number | 1205594546
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Entity Type | Organization
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Legal Business Name | MOSAIC COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 12/03/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 27 MELLOR AVE
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City | CATONSVILLE
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State | MD
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Zip | 21228-5106
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Country | US
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Telephone | 410-453-9553
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Fax | 443-612-1488
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Provider Business Mailing Address
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Address Line | 849 FAIRMOUNT AVE FL 5
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City | TOWSON
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State | MD
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Zip | 21286-2624
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Country | US
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Telephone | 410-382-8111
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Fax | 443-612-1488
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Authorized Official
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Title or Position | VP & COO COMMUNITY SERVICES
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Name | JEFFREY RICHARDSON
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Credential |
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Telephone | 410-453-9553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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