Pmg Opco-Colonial LLC
NPI #1124589544 in Bossier City, Louisiana
Provider Information
- NPI Number
- 1124589544
- Entity Type
- Organization
- Organization Name
- Pmg Opco-Colonial LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Mar 28, 2019
- Last Updated
- Mar 28, 2019
Practice Location
- Address
- 4921 MEDICAL DR
- City
- Bossier City
- State
- Louisiana
- ZIP Code
- 71112-4522
- Phone
- (318) 742-5420
Authorized Official
- Name
- STEVEN BOULWARE
- Title
- MANAGING MEMBER
- Phone
- (972) 428-0900
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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