Provider Demographics
NPI:1114263944
Name:NEW SHORES LLC
Entity Type:Organization
Organization Name:NEW SHORES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-865-3675
Mailing Address - Street 1:6060 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5209
Mailing Address - Country:US
Mailing Address - Phone:210-865-3675
Mailing Address - Fax:
Practice Address - Street 1:6060 N CENTRAL EXPY
Practice Address - Street 2:SUITE 560
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5209
Practice Address - Country:US
Practice Address - Phone:210-865-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid