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General NPI Number Information
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NPI Number | 1689742439
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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 | 12/01/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 261 CHAPMAN RD STE 201
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City | NEWARK
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State | DE
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Zip | 19702-5428
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Country | US
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Telephone | 302-456-5995
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Fax | 302-456-5998
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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 | 402-896-3884
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Fax | 402-896-1511
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Authorized Official
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Title or Position | SVP OF FINANCE
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Name | MR. SCOTT O 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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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