Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SVP CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
722 S 12TH ST, BEATRICE, NE 68310-4548
(402) 223-4066
(402) 223-4951
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0880062
PROVIDER #
IA
Enumeration date
04/11/2007
Last updated
10/12/2023
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