Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN WILSON (VP ACCOUNTING)
(402) 896-3884
Entity
Organization
Contact information
Practice address
217 E 7TH ST, LOGAN, IA 51546-1348
(712) 644-2378
(712) 664-3501
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
780204
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0896779
—
IA
Enumeration date
01/18/2007
Last updated
08/22/2020
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