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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