# PMG OPCO-ALPINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ALPINE SKILLED NURSING AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073074647
- **Authorized official:** STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (972) 428-0900

## Contact information

- **Practice address:** 2401 N SERVICE RD E, RUSTON, LA 71270-2342
- **Practice address phone:** (318) 255-6492
- **Mailing address:** 2401 N SERVICE RD E, RUSTON, LA 71270-2342

## Taxonomy

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

## Other

- **Enumeration date:** 03/27/2019
- **Last updated:** 03/27/2019