Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SVP/CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
110 W WATER ST STE 2, PONTIAC, IL 61764-1949
(815) 842-4166
(815) 842-4053
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
IL
Other
Enumeration date
01/05/2007
Last updated
09/28/2023
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