Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN WILSON (VP FINANCIAL OPERATIONS)
(402) 896-3884
Entity
Organization
Contact information
Practice address
106 E PARK ST, FOREST CITY, IA 50436-2103
(641) 585-5451
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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