Organization Active NPI

Mosaic

  • Intellectual Disabilities Intermediate Care Facility
  • Des Moines, IA
National Provider Identifier
1972655819
Registry record updated Jun 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
770042 Issued in IA
Legal business name
MOSAIC
Practice address
2317 Vine Street
Des Moines, IA 50265-0000
Phone
(515) 246-1840
Fax
(515) 246-8236
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2020

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)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 770042 IA Primary

Addresses

Primary practice location

2317 Vine Street
Des Moines, IA 50265-0000

Mailing address

4980 S 118TH St
Omaha, NE 68137-2220
Phone (402) 896-3884

Other identifiers 1

IdentifierTypeStateIssuer
0881870MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
Mosaic99 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1972655819",
    "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": "2317 VINE STREET",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "502650000",
            "telephone_number": "515-246-1840",
            "fax_number": "515-246-8236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "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": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IA",
            "license": "770042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0881870",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, 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.

Verify at the official NPI Registry.