MEDICARE: PLANTATION MANOR NURSING & REHABILITATION CENTER, LLC

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	23	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	:	1396726444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANTATION MANOR NURSING & REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 879
Second Line	:
City	:	WINNSBORO
State	:	LA
Zip	:	71295-0879
Country	:	US
Telephone Number	:	318-435-2225
Fax Number	:	318-435-2228

Provider Business Practice Location Address
First Line	:	6340 HIGHWAY 4
Second Line	:
City	:	WINNSBORO
State	:	LA
Zip	:	71295-7176
Country	:	US
Telephone Number	:	318-435-2225
Fax Number	:	318-435-2228

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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