MEDICARE: MOSAIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		IL

General Provider Information

NPI Number	:	1336291343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSAIC

Provider Business Mailing Address
First Line	:	4980 S 118TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-2220
Country	:	US
Telephone Number	:	402-896-3884
Fax Number	:	402-894-4780

Provider Business Practice Location Address
First Line	:	1111 S ALPINE RD STE 401
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-3940
Country	:	US
Telephone Number	:	815-387-8390
Fax Number	:	815-387-9055

Authorized Official
Title or Position	:	SVP/CHIEF FINANCIAL OFFICER
Name	:	SCOTT HOFFMAN
Credential	:
Telephone Number	:	402-896-3884

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/26/2023

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Directions to “MOSAIC ” Practice Location

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