# SHADY SHORES OF BERTRAM LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bertram Nursing and Rehab Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942685383
- **Authorized official:** MICHAEL WALLACE (CEO)
- **Authorized official phone:** (214) 422-1622

## Contact information

- **Practice address:** 540 E. HIGHWAY 29, BERTRAM, TX 78605-4473
- **Practice address phone:** (512) 355-2116
- **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:** 07/28/2015
- **Last updated:** 06/14/2016