Provider Demographics
NPI:1417402314
Name:MOSAIC COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:MOSAIC COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:410-453-9553
Mailing Address - Street 1:1925 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4128
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:410-612-1436
Practice Address - Street 1:15 S PARKE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-4515
Practice Address - Country:US
Practice Address - Phone:410-273-1399
Practice Address - Fax:410-273-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management