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	315P00000X	Intellectual Disabilities Intermediate Care Facility		NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720273386
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	:	2915 W FAIDLEY AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-4108
Country	:	US
Telephone Number	:	308-381-1690
Fax Number	:	308-381-6520

Authorized Official
Title or Position	:	INTERNAL AUDIT DIRECTOR
Name	:	KELLI POWELL
Credential	:
Telephone Number	:	402-698-9812

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	06/11/2025

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Directions to “MOSAIC ” Practice Location

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