Organization
COLONIAL MANOR GUEST HOUSE, LLC
Active
Other names
Colonial Manor Guest House
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TEDDY RAY PRICE (MANAGING MEMBER)
(318) 628-4116
Entity
Organization
Contact information
Practice address
114 WHATLEY ST, RAYVILLE, LA 71269-3318
(318) 728-3252
(318) 728-6552
Mailing address
PO BOX 874, RAYVILLE, LA 71269-0874
(318) 728-3252
(318) 728-6552
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
233
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1517151
—
LA
Enumeration date
11/07/2005
Last updated
08/22/2020
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