Organization
SHADY SHORES OF SAN SABA LLC
Active
Other names
Shady Shores of San Saba
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL WALLACE (CEO)
(940) 228-1414
Entity
Organization
Contact information
Practice address
2400 WEST BROWN ST., SAN SABA, TX 76877
(325) 455-3200
Mailing address
320 EAGLE DR, SUITE 201, DENTON, TX 76201-6898
(940) 228-1414
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001027949
—
TX
Enumeration date
02/25/2016
Last updated
11/14/2016
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