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Organization
PMG OPCO-SPRINGLAKE LLC
Active
Organization
PMG OPCO-SPRINGLAKE LLC
Active
Other names
SPRING LAKE SKILLED NURSING AND REHABILITATION
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN BOULWARE (MANAGING MEMBER)
(972) 428-0900
Entity
Organization
Contact information
Practice address
8622 LINE AVE, SHREVEPORT, LA 71106-6108
(318) 868-4126
(318) 868-9084
Mailing address
8622 LINE AVE, SHREVEPORT, LA 71106-6108
(318) 868-4126
(318) 868-9084
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/28/2019
Last updated
03/28/2019
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