Shady Oak Nursing and Rehabilitation, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

111107 Issued in TX

Legal business name

SHADY OAK NURSING AND REHABILITATION, LLC

Practice address

101 South Lancaster
Moulton, TX 77975-0120

Phone

(361) 596-7373

Fax

(361) 596-7671

NPI assigned

Jul 6, 2005

Last updated

Nov 5, 2010By 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

Mr. Byron M Burris II, LNFA

Title

President

Phone

(361) 576-9454

Specialties & licenses 1

Addresses

Other identifiers 4

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288915200000",
    "number": "1780681643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7230",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779037230",
            "telephone_number": "361-576-9454",
            "fax_number": "361-576-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SOUTH LANCASTER",
            "city": "MOULTON",
            "state": "TX",
            "postal_code": "779750120",
            "telephone_number": "361-596-7373",
            "fax_number": "361-596-7671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY OAK NURSING AND REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2010-11-05",
        "status": "A",
        "authorized_official_last_name": "BURRIS",
        "authorized_official_first_name": "BYRON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "361-576-9454",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "LNFA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "111107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171961902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171961901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4627",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001012451",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Citizens Medical Center County of Victoria (Shady Oak Nursing and Rehabilitation)
• Tanee Brooke Colburn, OT
• L & S Strength and Rehab Services LLC
• Moulton Isd
• Dale Edward Seifert, PT
• Wagner Medical Clinic L.L.P. (Moulton Clinic)
• West Wharton County Hospital District (Shady Oak Nursing and Rehabilitation)

• Skilled Nursing Facility in Moulton, TX
• Providers in Moulton, 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 Nov 5, 2010; 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.