Provider Demographics
NPI:1659595593
Name:MOSAIC REHABILITATION, INC
Entity Type:Organization
Organization Name:MOSAIC REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:ST
Authorized Official - Phone:425-644-6328
Mailing Address - Street 1:13010 NE 20TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2034
Mailing Address - Country:US
Mailing Address - Phone:425-644-6328
Mailing Address - Fax:425-644-6295
Practice Address - Street 1:2445 140TH AVE NE
Practice Address - Street 2:SUITE B105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1879
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:425-644-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation