Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT O HOFFMAN (SVP OF FINANCE)
(402) 896-3884
Entity
Organization
Contact information
Practice address
261 CHAPMAN RD STE 201, NEWARK, DE 19702-5428
(302) 456-5995
(302) 456-5998
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
(402) 896-3884
(402) 896-1511
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TR0400X
Rehabilitation Psychologist
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000036571
DE ELECTRONIC BILLING #
DE
05
—
200003867
—
DE
Enumeration date
12/01/2006
Last updated
09/18/2024
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