Organization
MOSAIC COMMUNITY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF RICHARDSON LCSW-C (CEO)
(410) 453-9553
Entity
Organization
Contact information
Practice address
2225 N CHARLES ST, BALTIMORE, MD 21218-5778
(410) 466-8277
(443) 612-1488
Mailing address
1925 GREENSPRING DR, TIMONIUM, MD 21093-4128
(410) 453-9553
(443) 612-1488
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
MH-1276
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH-1276
DHMH LICENSE
MD
Enumeration date
11/03/2015
Last updated
11/03/2015
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