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General NPI Number Information
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NPI Number | 1669016457
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Entity Type | Organization
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Legal Business Name | MOSAIC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 11141 AURORA AVE BLDG 3
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City | URBANDALE
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State | IA
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Zip | 50322-7904
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Country | US
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Telephone | 515-246-1840
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Fax | 515-246-8236
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Provider Business Mailing Address
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Address Line | 4980 S 118TH ST
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City | OMAHA
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State | NE
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Zip | 68137-2200
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Country | US
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Telephone | 402-896-5827
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Fax |
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Authorized Official
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Title or Position | SR VP & CHIEF FINANCIAL OFFICER
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Name | SCOTT HOFFMAN
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Credential |
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Telephone | 402-896-3884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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