Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERI SOLE (DIRECTOR OF PAYER RELATIONS)
(402) 968-1974
Entity
Organization
Contact information
Practice address
2542 E MARION ST, DES MOINES, IA 50320-2676
(402) 896-5827
(402) 894-4780
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
(402) 968-1974
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
04/20/2022
Last updated
04/20/2022
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