Active NPI
Shady Shores of Premont LLC
Doing business as Premont Rehab and Nursing Center
- Skilled Nursing Facility
- Premont, TX
National Provider Identifier
1881079101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- SHADY SHORES OF PREMONT LLC
- Doing business as
- Premont Rehab and Nursing Center
- Practice address
- 431 NW 3Rd St.
Premont, TX 78375 - Phone
- (361) 348-3553
- NPI assigned
- Jul 28, 2015
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | TX | Primary |
Addresses
Primary practice location
431 NW 3Rd St.
Premont, TX 78375
Mailing address
320 Eagle Dr
Suite 201
Denton, TX 76201-6898
Phone (940) 228-1414
Other names 1
- Premont Rehab and Nursing Center
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438041600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1465862400000",
"number": "1881079101",
"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": "431 NW 3RD ST.",
"city": "PREMONT",
"state": "TX",
"postal_code": "78375",
"telephone_number": "361-348-3553"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHADY SHORES OF PREMONT LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-28",
"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": "Premont Rehab and Nursing Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Premont, TX
Sources for this page
- 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.