# PMG OPCO-BOGALUSA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** RESTHAVEN LIVING CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033658893
- **Authorized official:** MR. STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (318) 658-9977

## Contact information

- **Practice address:** 1301 HARRISON ST, BOGALUSA, LA 70427-1700
- **Practice address phone:** (985) 732-3909
- **Mailing address:** 1301 HARRISON ST, BOGALUSA, LA 70427-1700
- **Mailing address phone:** (985) 732-3909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2017
- **Last updated:** 02/13/2017