Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SR VP & CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
220 N LAFAYETTE ST, MACOMB, IL 61455-2206
(309) 837-5506
(309) 833-3175
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
IL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/05/2007
Last updated
01/18/2024
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