SHORELINE INC. NPI 1962559252

NPI Information

NPI: 1962559252
Provider Name: SHORELINE, INC.
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 45D0954697

Address:
1220 GREGORY ST.
TAFT, TX
ZIP 78390
Phone: (361) 528-3356
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SHORELINE, INC. is a rehabilitation and substance use disorder clinic center in Taft, TX. SHORELINE, INC. NPI is 1962559252. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1220 GREGORY ST.
TAFT, TX
ZIP 78390-044
Phone: (361) 528-3356
Fax: (361) 528-3249

The provider's authorized official is Mark Jackson .
The authorized official title is Ceo and has the following contact phone number (361) 528-3356.

The CLIA number assigned to this NPI record is 45D0954697 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2007 and was last updated on 7/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0800X	Psychiatry & Neurology	Psychiatry			No
2	3245S0500X	Substance Abuse Rehabilitation Facility	Substance Abuse Treatment, Children	481A	TEXAS	No
3	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	065220801	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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