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
2708 N 11TH ST, GARDEN CITY, KS 67846-2714
(620) 275-9180
(620) 275-2565
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
KS
251C00000X
Developmentally Disabled Services Day Training Agency
—
KS
3747P1801X
Personal Care Attendant
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100008340A
TARG CASE MGMT
KS
01
—
200329400A
AGENCY RENDERING SVC #
KS
05
—
200329400B
—
KS
05
—
200329400L
—
KS
Enumeration date
01/04/2007
Last updated
01/18/2024
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