Provider Demographics
NPI:1821404369
Name:MOSAIC CULTURAL COMPLEX INCORPORATED
Entity Type:Organization
Organization Name:MOSAIC CULTURAL COMPLEX INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-963-3878
Mailing Address - Street 1:41 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1137
Mailing Address - Country:US
Mailing Address - Phone:508-471-5908
Mailing Address - Fax:
Practice Address - Street 1:41 PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1137
Practice Address - Country:US
Practice Address - Phone:508-471-5908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health