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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		IA

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	:	1972655991
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	:	11141 AURORA AVE
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-0000
Country	:	US
Telephone Number	:	515-246-1840
Fax Number	:	515-246-8236

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	01/18/2024

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Directions to “MOSAIC ” Practice Location

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