Organization
HICKORY MANOR NURSING & REHABILITATION CENTER, LLC
Active
Other names
Hickory Manor Nursing & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TEDDY RAY PRICE (MANAGING MEMBER)
(318) 628-4116
Entity
Organization
Contact information
Practice address
370 W HICKORY AVE, BASTROP, LA 71220-4442
(318) 281-6523
(318) 283-1097
Mailing address
PO BOX 69, BASTROP, LA 71221-0069
(318) 281-6523
(318) 283-1097
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
196
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520756
—
LA
Enumeration date
11/07/2005
Last updated
08/22/2020
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