Organization
SHORELINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK JACKSON (CEO)
(361) 528-3356
Entity
Organization
Contact information
Practice address
1220 GREGORY ST., TAFT, TX 78390-3044
(361) 528-3356
(361) 528-3249
Mailing address
1220 GREGORY ST, TAFT, TX 78390-3044
(361) 528-3356
(361) 528-3249
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
481A
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065220801
—
TX
Enumeration date
01/05/2007
Last updated
07/07/2023
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