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		IA
2	310500000X	Mental Illness Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0880062	OTHER	IA	PROVIDER #

General Provider Information

NPI Number	:	1386867901
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	:	722 S 12TH ST
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-4548
Country	:	US
Telephone Number	:	402-223-4066
Fax Number	:	402-223-4951

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	10/12/2023

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Directions to “MOSAIC ” Practice Location

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