# PMG OPCO-LAFAYETTE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CAMELOT REHABILITATION AT MAGNOLIA PARK
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689334799
- **Authorized official:** STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (972) 428-0900

## Contact information

- **Practice address:** 1511 DULLES DR, LAFAYETTE, LA 70506-3718
- **Practice address phone:** (337) 216-0950
- **Mailing address:** 1511 DULLES DR, LAFAYETTE, LA 70506-3718
- **Mailing address phone:** (337) 216-0950

## Taxonomy

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

## Other

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