PMG OPCO-SPRINGLAKE LLC NPI 1063974335

NPI Information

PMG OPCO-SPRINGLAKE LLC is an assisted living facility in Shreveport, LA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PMG OPCO-SPRINGLAKE LLC NPI is 1063974335. The provider is registered as an organization entity type.

The provider's business location address is:

8622 LINE AVE
SHREVEPORT, LA
ZIP 71106-108
Phone: (318) 861-2366

The provider's authorized official is Steven Boulware .
The authorized official title is Managing Member and has the following contact phone number (972) 428-0900.

The enumeration date for this NPI number is 4/4/2019 and was last updated on 4/4/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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