Organization
SHADY OAK NURSING AND REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BYRON M BURRIS II LNFA (PRESIDENT)
(361) 576-9454
Entity
Organization
Contact information
Practice address
101 SOUTH LANCASTER, MOULTON, TX 77975-0120
(361) 596-7373
(361) 596-7671
Mailing address
PO BOX 7230, VICTORIA, TX 77903-7230
(361) 576-9454
(361) 576-2994
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
111107
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001012451
—
TX
05
—
171961901
—
TX
05
—
171961902
—
TX
05
—
4627
—
TX
Enumeration date
07/06/2005
Last updated
11/05/2010
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