Organization
PMG OPCO-SPRINGLAKE LLC
Active
Other names
THE GABLES AT SPRINGLAKE
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) 861-2366
Mailing address
8622 LINE AVE, SHREVEPORT, LA 71106-6108
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/04/2019
Last updated
04/04/2019
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