Provider Demographics
NPI:1932714813
Name:MOSIAC
Entity type:Organization
Organization Name:MOSIAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-896-5827
Mailing Address - Street 1:4980 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2200
Mailing Address - Country:US
Mailing Address - Phone:402-896-5827
Mailing Address - Fax:
Practice Address - Street 1:1044 23 RD
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:NE
Practice Address - Zip Code:68924-3679
Practice Address - Country:US
Practice Address - Phone:402-896-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities