# PMG OPCO-BRADFORD 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:** THE BRADFORD SKILLED NURSING AND REHABILITATION
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952862377
- **Authorized official:** STEVEN BOULWARE (MANAGING MEMBER)
- **Authorized official phone:** (972) 428-0900

## Contact information

- **Practice address:** 3050 BAIRD RD, SHREVEPORT, LA 71118-3818
- **Practice address phone:** (318) 688-1010
- **Practice address fax:** (318) 688-1099
- **Mailing address:** 3050 BAIRD RD, SHREVEPORT, LA 71118-3818
- **Mailing address phone:** (318) 688-1010
- **Mailing address fax:** (318) 688-1099

## Taxonomy

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

## Other

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