MEDICARE: SAN SABA NURSING HOME, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	118466	TX

General Provider Information

NPI Number	:	1871616904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN SABA NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	608 S. EDGEWOOD ST.
Second Line	:
City	:	SAN SABA
State	:	TX
Zip	:	76877-5113
Country	:	US
Telephone Number	:	325-372-5179
Fax Number	:	325-372-3736

Provider Business Practice Location Address
First Line	:	608 S. EDGEWOOD ST.
Second Line	:
City	:	SAN SABA
State	:	TX
Zip	:	76877-5113
Country	:	US
Telephone Number	:	325-372-5179
Fax Number	:	325-372-3736

Authorized Official
Title or Position	:	BILLINB
Name	:	SHERRY WILLIAMSON
Credential	:
Telephone Number	:	325-372-5179

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/22/2020

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