NPI 1063974335

Pmg Opco-Springlake LLC

Organisation Assisted Living Facility Shreveport, LA

Practice location

Address: 8622 Line Ave, Shreveport, LA 71106-6108
Phone: (318) 861-2366

Authorised official

Name: Steven Boulware
Title: Managing Member
Phone: (972) 428-0900

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

Other Assisted Living Facility providers in Louisiana →

Registry record

NPI: 1063974335
Entity type: Organization
NPI issued: 4 Apr 2019
Record last updated: 4 Apr 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.