NPIMap

Organization Active NPI

Mosaic Community Services, Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Belcamp, MD
National Provider Identifier
1629522248
Registry record updated Aug 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
License
MH-2053 Issued in MD
Legal business name
MOSAIC COMMUNITY SERVICES, INC.
Practice address
4510 Wharf Point CT
Belcamp, MD 21017-1212
Phone
(410) 994-0600
Fax
(410) 994-0274
NPI assigned
Aug 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2016

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

Authorized official

Name
Jeff Richardson, CEO
Title
Chief Executive Officer
Phone
(410) 453-9553

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X MH-2053 MD Primary

Addresses

Primary practice location

4510 Wharf Point CT
Belcamp, MD 21017-1212

Mailing address

1925 Greenspring Dr
Timonium, MD 21093-4128
Phone (410) 453-9553

Other identifiers 1

IdentifierTypeStateIssuer
MH2053OtherMDDHMH LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Mosaic Community Services Inc47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

Organizations that report the same tax identification number in the National Provider Directory.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1470873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470873600000",
    "number": "1629522248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 GREENSPRING DR",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210934128",
            "telephone_number": "410-453-9553",
            "fax_number": "443-612-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 WHARF POINT CT",
            "city": "BELCAMP",
            "state": "MD",
            "postal_code": "210171212",
            "telephone_number": "410-994-0600",
            "fax_number": "410-994-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-11",
        "last_updated": "2016-08-11",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "410-453-9553",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "MD",
            "license": "MH-2053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHMH LICENSE",
            "identifier": "MH2053",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belcamp, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; 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.