# PMG OPCO-WASHINGTON LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** BOOKER T. WASHINGTON SKILLED NURSING AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184185654
- **Authorized official:** STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (972) 428-0900

## Contact information

- **Practice address:** 7605 LINE AVE, SHREVEPORT, LA 71106-5162
- **Practice address phone:** (318) 219-2608
- **Practice address fax:** (318) 861-7685
- **Mailing address:** 7605 LINE AVE, SHREVEPORT, LA 71106-5162
- **Mailing address phone:** (318) 219-2608
- **Mailing address fax:** (318) 861-7685

## Taxonomy

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

## Other

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