NPIMap

Organization Active NPI

PMG Opco-Alpine LLC

Doing business as Alpine Skilled Nursing and Rehabilitation

  • Skilled Nursing Facility
  • Ruston, LA
National Provider Identifier
1073074647
Registry record updated Mar 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PMG OPCO-ALPINE LLC
Doing business as
Alpine Skilled Nursing and Rehabilitation
Practice address
2401 N Service Rd E
Ruston, LA 71270-2342
Phone
(318) 255-6492
NPI assigned
Mar 27, 2019
Last updated
Mar 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 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
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2401 N Service Rd E
Ruston, LA 71270-2342

Mailing address

2401 N Service Rd E
Ruston, LA 71270-2342

Other names 1

  • ALPINE SKILLED NURSING AND REHABILITATION Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190426000804 LA Part A Provider - Skilled Nursing Facility 0042552838 Practice locations: Ruston, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073074647. Details of each certification follow.

Skilled nursing facility certification: CCN 195538

Legal name
PMG OPCO-ALPINE LLC
Doing business as
ALPINE SKILLED NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 11, 2002
Last certification
Dec 4, 2024
Beds
144
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Priority Management
Organization structure
LLCProprietary
Enrollment address
2401 N Service Rd
Ruston, LA 71270-2342
Nursing home name
ALPINE SKILLED NURSING AND REHABILITATION
Affiliated entity
PRIORITY MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Alpine Skilled Nursing and RehabilitationCCN 195538 · All quality measures
Overall star rating
1 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 11, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
144115.8 residents per day on average
Chain
Priority Management38 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0991896Alpine Skilled Nursing and Rehabilitation2401 North Service Road, Ruston, LA 71270Certificate of waiverOct 1, 2027

National Provider Directory

National Provider Directory

Locations

2401 N Service Rd E
Ruston, LA 71270
Phone (318) 255-6492

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Douglas B Boulware Individual 5% Or Greater Indirect Ownership InterestManaging Member of MGMT Company Apr 1, 2019 33.34%
Operational/Managerial ControlManaging Member Apr 1, 2019 33.34%
Indirect Ownership Interest Apr 1, 2019 33.34%
Organization, Lake Charles, LA LLC Adp of the SNF Apr 12, 2025
Organization, Lake Charles, LA LLC Adp of the SNF Apr 12, 2025
Individual Adp of the SNF Apr 1, 2019
Michael S Phillips Individual Adp of the SNF Apr 12, 2025
Organization, San Clemente, CA Adp of the SNF Apr 1, 2019
Organization, San Clemente, CA Corporation, Real estate investment trust (REIT) Adp of the SNF Apr 1, 2019
Priority Management Group, LLC Organization, Bossier City, LA LLC, Management services company, Chain home office Adp of the SNF Apr 12, 2025
Steven D Boulware Individual 5% Or Greater Indirect Ownership InterestManaging Member of MGMT Company Apr 1, 2019 33.33%
Indirect Ownership Interest Apr 1, 2019 33.33%
Individual Adp of the SNF Apr 1, 2019
Individual Adp of the SNF Apr 1, 2019
SDB Holdings Organization, Bossier City, LA LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 1, 2019 100%
Blake Wilson Individual Adp of the SNF Apr 12, 2025
Progressive Rehab Solutions, LLC Organization, Dallas, TX LLC Adp of the SNF Apr 1, 2019
Jessica Bennett Individual Adp of the SNF Sep 19, 2018
Organization, Bossier City, LA LLC Adp of the SNF Apr 12, 2025
William M Bauder Individual 5% Or Greater Indirect Ownership InterestManaging Member of MGMT Company Apr 1, 2019 33.33%
Indirect Ownership Interest Apr 1, 2019 33.33%
Organization, Bossier City, LA LLC Adp of the SNF Apr 12, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553644800000",
    "number": "1073074647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 N SERVICE RD E",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712702342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 N SERVICE RD E",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712702342",
            "telephone_number": "318-255-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMG OPCO-ALPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-27",
        "last_updated": "2019-03-27",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALPINE SKILLED NURSING AND REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruston, LA

Sources for this page

Verify at the official NPI Registry.