Provider Demographics
NPI:1053833038
Name:MOC CHANDLER, LLC
Entity Type:Organization
Organization Name:MOC CHANDLER, LLC
Other - Org Name:RAPID RECOVERY FROM MAINSTREET HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EZEKIEL
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-582-6200
Mailing Address - Street 1:14390 CLAY TERRACE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3669
Mailing Address - Country:US
Mailing Address - Phone:317-582-6961
Mailing Address - Fax:
Practice Address - Street 1:3033 SOUTH ARIZONA AVE.
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:317-689-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility