Provider Demographics
NPI:1972790947
Name:MOSAIC REHABILITATION INC.
Entity type:Organization
Organization Name:MOSAIC REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LUPUL
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:425-644-6328
Mailing Address - Street 1:2445 140TH AVE NE
Mailing Address - Street 2:SUITE B-105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1879
Mailing Address - Country:US
Mailing Address - Phone:425-644-6328
Mailing Address - Fax:425-644-6295
Practice Address - Street 1:2445 140TH AVE NE
Practice Address - Street 2:SUITE B-105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1879
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:425-644-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty