Provider Demographics
NPI:1356009674
Name:MOSAIC COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:MOSAIC COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP & COO COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-453-9553
Mailing Address - Street 1:849 FAIRMOUNT AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2624
Mailing Address - Country:US
Mailing Address - Phone:410-382-8111
Mailing Address - Fax:443-612-1488
Practice Address - Street 1:1925 GREENSPRING DR
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4128
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:443-612-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD190508574OtherSTATE LICENSE