NPIMap

Organization Active NPI

Mosaic Mission

  • Clinical Social Worker
  • Keego Harbor, MI
National Provider Identifier
1417503335
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MOSAIC MISSION
Practice address
2927 Glenbroke St
Keego Harbor, MI 48320-1102
Phone
(734) 972-5679
NPI assigned
Aug 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Kimberly D KellerNPI 1790911402
Title
Owner
Phone
(734) 972-5679

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

2927 Glenbroke St
Keego Harbor, MI 48320-1102

Mailing address

2927 Glenbroke St
Keego Harbor, MI 48320-1102
Phone (734) 972-5679

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1417503335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2927 GLENBROKE ST",
            "city": "KEEGO HARBOR",
            "state": "MI",
            "postal_code": "483201102",
            "telephone_number": "734-972-5679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2927 GLENBROKE ST",
            "city": "KEEGO HARBOR",
            "state": "MI",
            "postal_code": "483201102",
            "telephone_number": "734-972-5679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MISSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-15",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-972-5679"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Keego Harbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; 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.