Provider Demographics
NPI:1275177206
Name:MOSAIC HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:MOSAIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:MR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:VANTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:970-599-2057
Mailing Address - Street 1:1151 EAGLE DR # 344
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8020
Mailing Address - Country:US
Mailing Address - Phone:970-599-2057
Mailing Address - Fax:949-404-8845
Practice Address - Street 1:1136 E STUART ST BLDG 4 STE 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1195
Practice Address - Country:US
Practice Address - Phone:970-599-2057
Practice Address - Fax:949-404-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-02
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty