# SHADY SHORES OF CORPUS CHRISTI LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vista Del Mar Health & Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588022057
- **Authorized official:** MICHAEL WALLACE (CEO)
- **Authorized official phone:** (214) 422-1622

## Contact information

- **Practice address:** 1314 3RD ST, CORPUS CHRISTI, TX 78404-2208
- **Practice address phone:** (361) 888-5511
- **Practice address fax:** (361) 888-6267
- **Mailing address:** 320 EAGLE DR, SUITE 201, DENTON, TX 76201-6898
- **Mailing address phone:** (214) 422-1622
- **Mailing address fax:** (972) 755-6795

## Taxonomy

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

## Other

- **Enumeration date:** 01/29/2016
- **Last updated:** 01/29/2016