# PMG OPCO-GUEST HOUSE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE GUEST HOUSE SKILLED NURSING AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184185506
- **Authorized official:** STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (972) 428-0900

## Contact information

- **Practice address:** 9225 NORMANDIE DR, SHREVEPORT, LA 71118-3249
- **Practice address phone:** (318) 686-0515
- **Practice address fax:** (318) 687-0311
- **Mailing address:** 9225 NORMANDIE DR, SHREVEPORT, LA 71118-3249
- **Mailing address phone:** (318) 686-0515
- **Mailing address fax:** (318) 687-0311

## Taxonomy

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

## Other

- **Enumeration date:** 03/28/2019
- **Last updated:** 03/28/2019