Active NPI
Mosaic
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Waukon, IA
National Provider Identifier
1154478857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Legal business name
- MOSAIC
- Practice address
- 12 E Main
Suite 102
Waukon, IA 52172 - Phone
- (563) 568-3992
- Fax
- (563) 568-4789
- NPI assigned
- Jan 4, 2007
- Last updated
- Jun 11, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Scott Hoffman
- Title
- Senior VP & Chief Financial Officer
- Phone
- (402) 896-3884
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | IA | Primary |
Addresses
Primary practice location
12 E Main
Suite 102
Waukon, IA 52172
Mailing address
4980 S 118TH St
Omaha, NE 68137-2220
Phone (402) 896-3884
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0439158 | Medicaid | IA |
National Provider Directory
National Provider Directory- Tax ID family
- Mosaic
Organizations with this tax ID in the same state 18
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1053463992
-
- Intellectual Disabilities Intermediate Care Facility
- West Des Moines, IA
- NPI 1063564904
-
- Intellectual Disabilities Intermediate Care Facility
- Forest City, IA
- NPI 1093081960
-
- Intellectual Disabilities Intermediate Care Facility
- Clarion, IA
- NPI 1104192087
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1144372087
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1154473098
-
- Mental Illness Community Based Residential Treatment Facility
- Logan, IA
- NPI 1174663801
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1174675011
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1184776023
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1235281171
-
- Intellectual Disabilities Intermediate Care Facility
- Des Moines, IA
- NPI 1245382183
-
- Mental Illness Community Based Residential Treatment Facility
- Osceola, IA
- NPI 1245733310
Locations
12 E Main St
Ste 102
Waukon, IA 52172
Phone (563) 568-3992
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1591833600000",
"number": "1154478857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4980 S 118TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681372220",
"telephone_number": "402-896-3884",
"fax_number": "402-894-4780"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 E MAIN",
"address_2": "SUITE 102",
"city": "WAUKON",
"state": "IA",
"postal_code": "52172",
"telephone_number": "563-568-3992",
"fax_number": "563-568-4789"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOSAIC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-04",
"last_updated": "2020-06-11",
"certification_date": "2020-06-11",
"status": "A",
"authorized_official_last_name": "HOFFMAN",
"authorized_official_first_name": "SCOTT",
"authorized_official_title_or_position": "SENIOR VP & CHIEF FINANCIAL OFFICER",
"authorized_official_telephone_number": "402-896-3884"
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "IA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0439158",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Waukon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.