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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
1200 S 15TH ST, DENISON, IA 51442-2800
(712) 644-2378
(712) 664-3501
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780

Taxonomy

Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
240787
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0882001
IA
Enumeration date
01/18/2007
Last updated
11/06/2020
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