Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT HOFFMAN (SR VP & CHIEF FINANC)
(402) 896-3884
Entity
Organization
Contact information
Practice address
441 INDUSTRIAL PARK AVE, LIBERAL, KS 67901-5107
(620) 624-3817
(620) 626-4507
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
KS
251C00000X
Developmentally Disabled Services Day Training Agency
—
KS
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
3747P1801X
Personal Care Attendant
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100008340A
TCM
KS
01
—
200329400 I
LIBERAL'S TCM #
KS
01
—
200329400H
RESIDENTIAL, VOCATIONAL
KS
01
—
200329400M
NON-EMERGENCY TRANS
KS
Enumeration date
01/04/2007
Last updated
01/18/2024
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