NPIMap

Organization Active NPI

Hickory Manor Skilled Nursing Facility, LLC

  • Skilled Nursing Facility
  • Bastrop, LA
National Provider Identifier
1316262264
Registry record updated Apr 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
196 Issued in LA
Legal business name
HICKORY MANOR SKILLED NURSING FACILITY, LLC
Practice address
370 W Hickory Ave
Bastrop, LA 71220-4442
Phone
(318) 281-6523
NPI assigned
Apr 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles Goodwin Gladney
Title
Managing Partner
Phone
(318) 281-0078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 196 LA Primary

Addresses

Primary practice location

370 W Hickory Ave
Bastrop, LA 71220-4442

Mailing address

1523 Texas Ave
Bastrop, LA 71220-4043
Phone (318) 281-0078

National Provider Directory

National Provider Directory
Tax ID family
Hickory Manor Nursing Rehabilitation Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270425600000",
    "number": "1316262264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 TEXAS AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204043",
            "telephone_number": "318-281-0078",
            "fax_number": "318-281-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 W HICKORY AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204442",
            "telephone_number": "318-281-6523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY MANOR SKILLED NURSING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-05",
        "last_updated": "2010-04-05",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "GOODWIN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "318-281-0078"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.