Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
5440 W 110TH ST STE 300, LEAWOOD, KS 66211-1221
(913) 788-8400
(913) 788-2257
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2220
(402) 896-3884
(402) 894-4780
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
KS
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100008300A
KCDS
KS
01
—
100260930A
WYANDOTTE COUNTY CDDO
KS
05
—
200329400N
—
KS
05
—
200329400O
—
KS
Enumeration date
01/04/2007
Last updated
09/24/2024
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