# SHADY SHORES OF SAN SABA LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Shady Shores of San Saba
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326408832
- **Authorized official:** MICHAEL WALLACE (CEO)
- **Authorized official phone:** (940) 228-1414

## Contact information

- **Practice address:** 2400 WEST BROWN ST., SAN SABA, TX 76877
- **Practice address phone:** (325) 455-3200
- **Mailing address:** 320 EAGLE DR, SUITE 201, DENTON, TX 76201-6898
- **Mailing address phone:** (940) 228-1414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |

## Other

- **Enumeration date:** 02/25/2016
- **Last updated:** 11/14/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001027949 | — | TX |