Provider Demographics
NPI:1669632147
Name:MOSAIC COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:MOSAIC COMMUNITY SERVICES, INC.
Other - Org Name:SHEPPARD PRATT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-382-8111
Mailing Address - Street 1:PO BOX 45709
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5709
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:443-612-1488
Practice Address - Street 1:288 E GREEN ST, BLDGS A & B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5410
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:410-751-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD159380304Medicaid
MD911LMedicare PIN