Organization
MOSAIC COMMUNITY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN PARK HARTZOG (EXECUTIVE DIRECTOR)
(573) 225-7614
Entity
Organization
Contact information
Practice address
602 MATTHEWS AVE, SIKESTON, MO 63801-3259
(573) 621-5160
(573) 621-5161
Mailing address
602 MATTHEWS AVE, P.O. BOX 1522, SIKESTON, MO 63801-3259
(573) 621-5160
(573) 621-5161
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320900000X
—
MO
Enumeration date
03/20/2015
Last updated
04/02/2015
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