Organization
PMG OPCO-BOGALUSA LLC
Active
Other names
RESTHAVEN LIVING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN BOULWARE (MANAGING MEMBER)
(318) 658-9977
Entity
Organization
Contact information
Practice address
1301 HARRISON ST, BOGALUSA, LA 70427-1700
(985) 732-3909
Mailing address
1301 HARRISON ST, BOGALUSA, LA 70427-1700
(985) 732-3909
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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