Provider Demographics
NPI:1487702098
Name:MOSAIC COMMUNITY SERVICES MEDICAL DAY
Entity type:Organization
Organization Name:MOSAIC COMMUNITY SERVICES MEDICAL DAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-453-9553
Mailing Address - Street 1:1925 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4128
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:
Practice Address - Street 1:7 BLOOMSBURY AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4641
Practice Address - Country:US
Practice Address - Phone:410-453-9553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty