NPIMap

Organization Active NPI

PMG Opco-Springlake LLC

Doing business as The Gables at Springlake

  • Assisted Living Facility
  • Shreveport, LA
National Provider Identifier
1063974335
Registry record updated Apr 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
PMG OPCO-SPRINGLAKE LLC
Doing business as
The Gables at Springlake
Practice address
8622 Line Ave
Shreveport, LA 71106-6108
Phone
(318) 861-2366
NPI assigned
Apr 4, 2019
Last updated
Apr 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU Primary

Addresses

Primary practice location

8622 Line Ave
Shreveport, LA 71106-6108

Mailing address

8622 Line Ave
Shreveport, LA 71106-6108

Other names 1

  • THE GABLES AT SPRINGLAKE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PMG Opco-Springlake LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554336000000",
    "number": "1063974335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8622 LINE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711066108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8622 LINE AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711066108",
            "telephone_number": "318-861-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMG OPCO-SPRINGLAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-04",
        "last_updated": "2019-04-04",
        "status": "A",
        "authorized_official_last_name": "BOULWARE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "972-428-0900"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE GABLES AT SPRINGLAKE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.