NPI 1124589544

Pmg Opco-Colonial LLC

Organisation Skilled Nursing Facility Bossier City, LA

Practice location

Address: 4921 Medical Dr, Bossier City, LA 71112-4522
Phone: (318) 742-5420
Fax: (318) 742-8887

Authorised official

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

Registered specialties

Skilled Nursing Facility Primary

Nursing & Custodial Care Facilities Taxonomy 314000000X

Other Skilled Nursing Facility providers in Louisiana →

Registry record

NPI: 1124589544
Entity type: Organization
NPI issued: 28 Mar 2019
Record last updated: 28 Mar 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.