MEDICARE: WYATT MANOR NURSING & REHABILITATION CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	151	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427039585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYATT MANOR NURSING & REHABILITATION CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 279
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-0279
Country	:	US
Telephone Number	:	318-259-2814
Fax Number	:	318-259-8439

Provider Business Practice Location Address
First Line	:	4659 HIGHWAY 505
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-5891
Country	:	US
Telephone Number	:	318-259-2814
Fax Number	:	318-259-8439

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. TEDDY RAY PRICE
Credential	:
Telephone Number	:	318-628-4116

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/12/2024

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