Pmg Opco-Colonial LLC
Skilled Nursing Facility in Bossier City, LA. Organization (NPI-2).
NPI number1124589544
StatusActive
Last updated in NPPESMar 28, 2019
Details
- NPI
- 1124589544
- Entity type
- Organization (NPI-2)
- Legal business name
- Pmg Opco-Colonial LLC
- Organization subpart
- No
- Enumeration date
- Mar 28, 2019
- Last updated
- Mar 28, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | – | – | Yes |
Other names
- Colonial Oaks Skilled Nursing And Rehabilitation (Doing Business As)
Practice location
4921 Medical DrBossier City, LA 71112-4522
Phone 318-742-5420 · Fax 318-742-8887
Mailing address
4921 Medical DrBossier City, LA 71112-4522
Phone 318-742-5420 · Fax 318-742-8887
Authorized official
Steven Boulware
Managing Member
9724280900
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