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General NPI Number Information
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NPI Number | 1255509493
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Entity Type | Organization
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Legal Business Name | MOSAIC COMMUNITY SERVICES
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 2225 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5778
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Country | US
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Telephone | 410-366-4360
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Fax | 410-662-8547
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Provider Business Mailing Address
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Address Line | 1925 GREENSPRING DR
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City | TIMONIUM
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State | MD
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Zip | 21093-4128
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Country | US
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Telephone | 410-453-9553
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JEFFREY W RICHARDSON
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Credential | LCSW-C
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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 | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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