Organization
LICKING NO 1 LLC
Active
Other names
Hickory Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD B BEDELL (PRESIDENT)
(573) 471-1276
Entity
Organization
Contact information
Practice address
209 HICKORY ST, LICKING, MO 65542
(573) 674-2111
Mailing address
731 N MAIN ST, SIKESTON, MO 63801-2151
(573) 471-1276
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
046854
MO
Other
Enumeration date
08/24/2017
Last updated
08/24/2018
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