Healthcare Provider Details

I. General information

NPI: 1033654603
Provider Name (Legal Business Name): MOC ROUND ROCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16219 RANCH ROAD 620 N
AUSTIN TX
78717
US

IV. Provider business mailing address

1320 ARROW POINT DR STE 506
CEDAR PARK TX
78613-2189
US

V. Phone/Fax

Practice location:
  • Phone: 183-452-0512
  • Fax: 737-202-4399
Mailing address:
  • Phone: 512-524-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MARK FRITZ
Title or Position: PRESIDENT
Credential:
Phone: 512-524-7321