Provider Demographics
NPI:1336288950
Name:MACIAS, MCKENZIE, MORENO, LLC
Entity Type:Organization
Organization Name:MACIAS, MCKENZIE, MORENO, LLC
Other - Org Name:OUT N' ABOUT DAY TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-851-0311
Mailing Address - Street 1:115 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1728
Mailing Address - Country:US
Mailing Address - Phone:361-851-0311
Mailing Address - Fax:
Practice Address - Street 1:4626 WEBER RD
Practice Address - Street 2:SUITE 21
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-3543
Practice Address - Country:US
Practice Address - Phone:361-851-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services