SHADY OAK NURSING AND REHABILITATION, LLC
NPI 1780681643
Skilled Nursing Facility in Moulton, TX

Active since July 06, 2005CLIA 45D0679802 · Waiver
101 SOUTH LANCASTER, MOULTON, TX 77975(361) 596-7373(361) 596-7671 Get Directions Write a Review

NPPES record last updated: November 5, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shady Oak Nursing And Rehabilitation, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY OAK NURSING AND REHABILITATION, LLC (NPI 1780681643) is a healthcare organization registered as a skilled nursing facility in Moulton, Texas and active in the NPI registry since July 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Byron M Burris, President, as its authorized official.

NPPES Registry Identity

NPI1780681643
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameSHADY OAK NURSING AND REHABILITATION, LLC
Location Address101 SOUTH LANCASTERMoulton, TX 77975-0120
Mailing AddressPo Box 7230Victoria, TX 77903-7230 · (361) 576-9454 · Fax (361) 576-2994
Fax(361) 596-7671
Organization SubpartNo
Authorized OfficialByron M BurrisPresident · (361) 576-9454
Enumeration DateJuly 6, 2005
Last NPPES UpdateNovember 5, 2010
NPI 1780681643 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in TX · 111107
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
101 SOUTH LANCASTER, Moulton, TX 77975

Other Identifiers 6

Medicaid171961901TX
Medicaid4627TX
Medicaid171961902TX
Medicaid001012451TX
Medicare OSCAR/certification676030TX
Medicare NSC5205630001TX

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D0679802

Shady Oak Nursing And Rehabilitation · Victoria, TX
Active · expires Aug 31, 2026
CLIA Number45D0679802
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorElizabeth B. Marrs
Laboratory Phone(512) 596-7373
Laboratory LocationShady Oak Nursing And Rehabilitation115 Medical Drive, Suit 200, Victoria, TX 77904
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
101 SOUTH LANCASTER
MOULTON, TX 77975
Skilled Nursing Facility
101 SOUTH LANCASTER
MOULTON, TX 77975

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Oak Nursing And Rehabilitation, LLC's NPI number?

The NPI number for Shady Oak Nursing And Rehabilitation, LLC is 1780681643. It was assigned to this organization in the NPPES registry on July 6, 2005.

Where is Shady Oak Nursing And Rehabilitation, LLC located?

Shady Oak Nursing And Rehabilitation, LLC is located at 101 South Lancaster, Moulton, TX 77975. The listed phone number is (361) 596-7373.

What is Shady Oak Nursing And Rehabilitation, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Shady Oak Nursing And Rehabilitation, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D0679802) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shady Oak Nursing And Rehabilitation, LLC was last updated on November 5, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.