Organization
PMG OPCO-BROUSSARD LLC
Active
Other names
CAMELOT OF BROUSSARD
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN BOULWARE (MANAGING MEMBER)
(972) 428-0900
Entity
Organization
Contact information
Practice address
418 ALBERTSON PKWY, BROUSSARD, LA 70518-4971
(337) 839-9005
Mailing address
418 ALBERTSON PKWY, BROUSSARD, LA 70518-4971
(337) 839-9005
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
12/30/2021
Last updated
12/30/2021
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