Provider Demographics
NPI:1023557097
Name:MOC WACO LLC
Entity Type:Organization
Organization Name:MOC WACO LLC
Other - Org Name:RAPID RECOVERY CENTER OF WACO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-277-3345
Mailing Address - Street 1:1101 ARROW POINT DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7737
Mailing Address - Country:US
Mailing Address - Phone:512-277-3345
Mailing Address - Fax:
Practice Address - Street 1:5801 CROSSLAKE PKWY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6948
Practice Address - Country:US
Practice Address - Phone:254-420-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility