Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN WILSON (VP ACCOUNTING)
(402) 896-3884
Entity
Organization
Contact information
Practice address
217 E 7TH ST, LOGAN, IA 51546-1348
(712) 644-2378
(712) 664-3501
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
2439232
IA
Other
Enumeration date
02/08/2007
Last updated
08/22/2020
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