Shady Shores of Poteet LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SHADY SHORES OF POTEET LLC

Doing business as

Poteet Manor

Practice address

329 School Dr
Poteet, TX 78065-4307

Phone

(830) 742-3525

Fax

(830) 742-8710

NPI assigned

Nov 30, 2015

Last updated

Jun 14, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Wallace

Title

Ceo

Phone

(214) 422-1622

Specialties & licenses 1

Addresses

Other names 1

• Poteet Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465862400000",
    "number": "1487028585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 EAGLE DR",
            "address_2": "SUITE 201",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762016898",
            "telephone_number": "940-228-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 SCHOOL DR",
            "city": "POTEET",
            "state": "TX",
            "postal_code": "780654307",
            "telephone_number": "830-742-3525",
            "fax_number": "830-742-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY SHORES OF POTEET LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "last_updated": "2016-06-14",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-422-1622"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poteet Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Vanessa Salazar
• Latonya Shadowens, NP
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• Victoria Dina Maire Steele
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• Timberland Medical Group (South Texas Family Care)

• Skilled Nursing Facility in Poteet, TX
• Providers in Poteet, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.