| Organization Name: | MOSAIC COMMUNITY SERVICES, LLC |
| NPI Number: | 1134513765 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BENJAMIN PARK HARTZOG (EXECUTIVE DIRECTOR) |
| Mailing Address: | 602 Matthews Ave Sikeston |
| State: | MO US |
| Postal Code: | 638013259 |
| Phone Number: | 5736215160 |
| Fax Number: | 5736215161 |
| NPI Enumeration Date: | 03/20/2015 |
| NPI Last Update Date: | 04/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |