Provider Demographics
NPI:1407171507
Name:MOSAIC, INC
Entity Type:Organization
Organization Name:MOSAIC, INC
Other - Org Name:MOSAIC REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-388-4988
Mailing Address - Street 1:6325 JACKRABBIT LN
Mailing Address - Street 2:STE A
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9128
Mailing Address - Country:US
Mailing Address - Phone:406-388-4988
Mailing Address - Fax:406-388-6188
Practice Address - Street 1:6325 JACKRABBIT LN
Practice Address - Street 2:STE A
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9128
Practice Address - Country:US
Practice Address - Phone:406-388-4988
Practice Address - Fax:406-388-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9393261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011003908Medicare PIN