Organization
PMG OPCO-PILGRIM LLC
Active
Other names
PILGRIM MANOR 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
1524 DOCTORS DR, BOSSIER CITY, LA 71111-3322
(318) 742-1623
(318) 742-2878
Mailing address
1524 DOCTORS DR, BOSSIER CITY, LA 71111-3322
(318) 742-1623
(318) 742-2878
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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