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
12107 TOEPPERWEIN RD, SUITE 2, LIVE OAK, TX 78233-3136
(210) 967-0566
(210) 967-6232
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
TX
251C00000X
Developmentally Disabled Services Day Training Agency
—
TX
251S00000X
Community/Behavioral Health Agency
—
TX
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
Other
Enumeration date
02/02/2007
Last updated
09/11/2025
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