Citizens Medical Center County of Victoria

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CITIZENS MEDICAL CENTER COUNTY OF VICTORIA

Doing business as

Shady Oak Nursing and Rehabilitation

Practice address

101 South Lancaster
Moulton, TX 77975-0120

Phone

(361) 596-7373

Fax

(361) 596-7671

NPI assigned

Dec 20, 2013

Last updated

Aug 22, 2014By 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

Stephen Thames

Title

Ceo

Phone

(361) 573-9181

Specialties & licenses 1

Addresses

Other names 1

• Shady Oak Nursing and Rehabilitation Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Citizens Medical Center County of Victoria

  dba Southbrooke Manor Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Edna, TX
  • NPI 1801217997

  Member Of

  NPD member

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

{
    "created_epoch": "1387497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408665600000",
    "number": "1902227747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 HOSPITAL DR",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779015748",
            "telephone_number": "361-573-9181"
        },
        {
            "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": "CITIZENS MEDICAL CENTER COUNTY OF VICTORIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-20",
        "last_updated": "2014-08-22",
        "status": "A",
        "authorized_official_last_name": "THAMES",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "361-573-9181"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shady Oak Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanee Brooke Colburn, OT
• L & S Strength and Rehab Services LLC
• Moulton Isd
• Dale Edward Seifert, PT
• Shady Oak Nursing and Rehabilitation, LLC

• 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 Aug 22, 2014; 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.