Organization
MOSAIC COMMUNITY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF RICHARDSON CEO (CHIEF EXECUTIVE OFFICER)
(410) 453-9553
Entity
Organization
Contact information
Practice address
4510 WHARF POINT CT, BELCAMP, MD 21017-1212
(410) 994-0600
(410) 994-0274
Mailing address
1925 GREENSPRING DR, TIMONIUM, MD 21093-4128
(410) 453-9553
(443) 612-1436
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
MH-2053
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MH2053
DHMH LICENSE
MD
Enumeration date
08/11/2016
Last updated
08/11/2016
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