Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERI SOLE (DIRECTOR OF BILLING)
(402) 896-5827
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
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1439232
—
IA
Enumeration date
01/18/2007
Last updated
11/04/2020
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