Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4659 HIGHWAY 505
JONESBORO LA
71251-5891
US

IV. Provider business mailing address

PO BOX 279
JONESBORO LA
71251-0279
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-2814
  • Fax: 318-259-8439
Mailing address:
  • Phone: 318-259-2814
  • Fax: 318-259-8439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number151
License Number StateLA

VIII. Authorized Official

Name: MR. TEDDY RAY PRICE
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-628-4116