Organization
PMG OPCO-LAFAYETTE LLC
Active
Other names
CAMELOT REHABILITATION AT MAGNOLIA PARK
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN BOULWARE (MANAGING MEMBER)
(972) 428-0900
Entity
Organization
Contact information
Practice address
1511 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 216-0950
Mailing address
1511 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 216-0950
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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