Mosaic Community Services, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

MOSAIC COMMUNITY SERVICES, LLC

Practice address

602 Matthews Ave
Sikeston, MO 63801-3259

Phone

(573) 621-5160

Fax

(573) 621-5161

NPI assigned

Mar 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Benjamin Park Hartzog

Title

Executive Director

Phone

(573) 225-7614

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1134513765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MATTHEWS AVE",
            "address_2": "P.O. BOX 1522",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638013259",
            "telephone_number": "573-621-5160",
            "fax_number": "573-621-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MATTHEWS AVE",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638013259",
            "telephone_number": "573-621-5160",
            "fax_number": "573-621-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC COMMUNITY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "HARTZOG",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "PARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "573-225-7614",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "320900000X",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tina L. Moore, APRN, BC-FNP
• James Jeremiah Mooty, FNP
• Brad Morgan, PTA
• Helen Morrill, PMHNP
• Allegra Anne Morris I
• Haytham Mostafa
• Jaime Motter, PHARM. D.
• Ernest Ray Moxey, RPH
• Kenneth CHI-Kong Moy, DO
• Timothy James Hoe-Yan Moy, DC

• In Home Supportive Care Agency in Sikeston, MO
• Providers in Sikeston, MO by specialty
• In Home Supportive Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.