Organization
MOSAIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT HOFFMAN (SVP CHIEF FINANCIAL OFFICER)
(402) 896-3884
Entity
Organization
Contact information
Practice address
1044 23RD RD, AXTELL, NE 68924-3679
(308) 743-2401
(308) 743-2659
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
ICFMR02
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10025284000
PROVIDER NUMBER
NE
Enumeration date
06/07/2007
Last updated
01/18/2024
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