Provider Demographics
NPI:1598444184
Name:MOSAIC COMMUNITY LIVING HCS, LLC
Entity Type:Organization
Organization Name:MOSAIC COMMUNITY LIVING HCS, LLC
Other - Org Name:MOSAIC COMMUNITY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIGETTE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:346-946-2042
Mailing Address - Street 1:23642 CROSSWORTH DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-1758
Mailing Address - Country:US
Mailing Address - Phone:346-946-2042
Mailing Address - Fax:
Practice Address - Street 1:23642 CROSSWORTH DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-1758
Practice Address - Country:US
Practice Address - Phone:346-946-2042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)