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Organization
HICKORY MANOR SKILLED NURSING FACILITY, LLC
Active
Organization
HICKORY MANOR SKILLED NURSING FACILITY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GOODWIN GLADNEY (MANAGING PARTNER)
(318) 281-0078
Entity
Organization
Contact information
Practice address
370 W HICKORY AVE, BASTROP, LA 71220-4442
(318) 281-6523
Mailing address
1523 TEXAS AVE, BASTROP, LA 71220-4043
(318) 281-0078
(318) 281-2753
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
196
LA
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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