NPIMap

Organization Active NPI

Hickory Manor Nursing & Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Bastrop, LA
National Provider Identifier
1992786024
Registry record updated Aug 22, 2020
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 NURSING & REHABILITATION CENTER, LLC
Doing business as
Hickory Manor Nursing & Rehabilitation Center
Practice address
370 W Hickory Ave
Bastrop, LA 71220-4442
Phone
(318) 281-6523
Fax
(318) 283-1097
NPI assigned
Nov 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Teddy Ray Price
Title
Managing Member
Phone
(318) 628-4116

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

PO Box 69
Bastrop, LA 71221-0069
Phone (318) 281-6523

Other identifiers 1

IdentifierTypeStateIssuer
1520756MedicaidLA

Other names 1

  • Hickory Manor Nursing & Rehabilitation Center Doing business as

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": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992786024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712210069",
            "telephone_number": "318-281-6523",
            "fax_number": "318-283-1097"
        },
        {
            "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",
            "fax_number": "318-283-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HICKORY MANOR NURSING & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "TEDDY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "318-628-4116",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "LA",
            "license": "196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520756",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hickory Manor Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 22, 2020; 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.