Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SENIOR VP & CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
4220 EAST DOUGLAS, DES MOINES, IA 50317-0000
(515) 246-1840
(515) 246-8236
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
770992
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0881912
—
IA
Enumeration date
01/18/2007
Last updated
01/18/2024
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