Provider Demographics
NPI: | 1467973404 |
---|---|
Name: | MOC FORT WORTH LLC |
Entity Type: | Organization |
Organization Name: | MOC FORT WORTH LLC |
Other - Org Name: | RAPID RECOVERY CENTER OF FORT WORTH |
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 STE 210 |
Mailing Address - Street 2: | |
Mailing Address - City: | CEDAR PARK |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78613-7739 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-277-3345 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6301 OAKMONT BLVD |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76132-2814 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-277-3345 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-06-29 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 314000000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |