# HICKORY MANOR SKILLED NURSING FACILITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316262264
- **Authorized official:** CHARLES GOODWIN GLADNEY (MANAGING PARTNER)
- **Authorized official phone:** (318) 281-0078

## Contact information

- **Practice address:** 370 W HICKORY AVE, BASTROP, LA 71220-4442
- **Practice address phone:** (318) 281-6523
- **Mailing address:** 1523 TEXAS AVE, BASTROP, LA 71220-4043
- **Mailing address phone:** (318) 281-0078
- **Mailing address fax:** (318) 281-2753

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 196 | LA | Yes |

## Other

- **Enumeration date:** 04/05/2010
- **Last updated:** 04/05/2010