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Organization

MOSAIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JERI SOLE (DIRECTOR OF BILLING)
(402) 896-5827
Entity
Organization

Contact information

Practice address
2120 E 9TH AVE, WINFIELD, KS 67156-3318
(620) 229-8702
(620) 229-8760
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
Primary
KS
251E00000X
Home Health Agency
KS
343900000X
Non-emergency Medical Transport (VAN)
KS
3747P1801X
Personal Care Attendant
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
200329400 J
NEMT
KS
01
200329400C
TCM
KS
01
200329400D
HCBS RESIDENTIAL
KS
Enumeration date
01/18/2007
Last updated
11/06/2020
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