Provider Demographics
NPI:1013452689
Name:MOC SAN ANTONIO II LLC
Entity Type:Organization
Organization Name:MOC SAN ANTONIO II LLC
Other - Org Name:RAPID RECOVERY CENTER OF SAN ANTONIO
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:512-657-8585
Mailing Address - Street 1:1320 ARROW POINT DR STE 506
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2189
Mailing Address - Country:US
Mailing Address - Phone:512-524-7321
Mailing Address - Fax:
Practice Address - Street 1:6035 ECKHERT RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3164
Practice Address - Country:US
Practice Address - Phone:210-642-5300
Practice Address - Fax:210-642-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001029573Medicaid