Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SENIOR VP & CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
12 E MAIN, SUITE 102, WAUKON, IA 52172
(563) 568-3992
(563) 568-4789
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(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
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0439158
—
IA
Enumeration date
01/04/2007
Last updated
06/11/2020
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