Provider Demographics
NPI:1922271824
Name:MOSAIC
Entity Type:Organization
Organization Name:MOSAIC
Other - Org Name:MOSAIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA HS, MS PA
Authorized Official - Phone:877-366-7242
Mailing Address - Street 1:4980 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2220
Mailing Address - Country:US
Mailing Address - Phone:877-366-7242
Mailing Address - Fax:
Practice Address - Street 1:4980 S 118TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2220
Practice Address - Country:US
Practice Address - Phone:877-366-7242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities