# PMG OPCO-BROUSSARD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CAMELOT OF BROUSSARD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326708439
- **Authorized official:** STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (972) 428-0900

## Contact information

- **Practice address:** 418 ALBERTSON PKWY, BROUSSARD, LA 70518-4971
- **Practice address phone:** (337) 839-9005
- **Mailing address:** 418 ALBERTSON PKWY, BROUSSARD, LA 70518-4971
- **Mailing address phone:** (337) 839-9005

## Taxonomy

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

## Other

- **Enumeration date:** 12/30/2021
- **Last updated:** 12/30/2021