Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN WILSON (VP ACCOUNTING)
(402) 896-3884
Entity
Organization
Contact information
Practice address
2245 MIDWAY RD, SUITE 300, CARROLLTON, TX 75006-4960
(972) 866-9989
(972) 991-0834
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
Other
Enumeration date
02/02/2007
Last updated
08/22/2020
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