Provider Demographics
NPI:1982454609
Name:MOSAIC
Entity type:Organization
Organization Name:MOSAIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP AND CHIEF FINANCIAL OFFIC
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-896-3884
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:402-698-9812
Mailing Address - Fax:402-896-1511
Practice Address - Street 1:2929 N 44TH ST STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7278
Practice Address - Country:US
Practice Address - Phone:602-864-6030
Practice Address - Fax:602-864-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ866668Medicaid
AZDDD704011Medicaid