Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SR VP & CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
122 N DOUGLAS AVE, ELLSWORTH, KS 67439-3214
(785) 472-4081
(785) 472-3851
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
—
KS
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
KS
3747P1801X
Personal Care Attendant
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200329400E
CASE MGMT
KS
01
—
200329400K
HCBS
KS
Enumeration date
01/18/2007
Last updated
02/06/2024
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