Pmg Opco-Bridgeport LLC
NPI #1114469046 in Bridgeport, Texas
Provider Information
- NPI Number
- 1114469046
- Entity Type
- Organization
- Organization Name
- Pmg Opco-Bridgeport LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Nov 9, 2016
- Last Updated
- Nov 9, 2016
Practice Location
- Address
- 2106 15TH ST
- City
- Bridgeport
- State
- Texas
- ZIP Code
- 76426-2073
- Phone
- (940) 683-6307
Authorized Official
- Name
- DOUGLAS B BOULWARE
- Title
- MANAGING MEMBER
- Phone
- (318) 658-9977
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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