Provider Demographics
NPI:1336815026
Name:MOSAIC LEARNING CENTER LLC
Entity Type:Organization
Organization Name:MOSAIC LEARNING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-665-5022
Mailing Address - Street 1:12291 FORT CUSTER DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-8797
Mailing Address - Country:US
Mailing Address - Phone:269-615-8674
Mailing Address - Fax:
Practice Address - Street 1:9880 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-8641
Practice Address - Country:US
Practice Address - Phone:269-665-5022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-21
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty