NPIMap

Organization Active NPI

PMG Opco-Colonial LLC

  • Skilled Nursing Facility
  • Bossier City, LA
National Provider Identifier
1124589544
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PMG OPCO-COLONIAL LLC
Practice address
4921 Medical Dr
Bossier City, LA 71112-4522
Phone
(318) 742-5420
Fax
(318) 742-8887
NPI assigned
Mar 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 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

4921 Medical Dr
Bossier City, LA 71112-4522

Mailing address

4921 Medical Dr
Bossier City, LA 71112-4522
Phone (318) 742-5420

Other names 1

  • COLONIAL OAKS 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
O20190509001570 LA Part A Provider - Skilled Nursing Facility 0446593644 Practice locations: Bossier City, LA

Skilled nursing facility certification: CCN 195604

Legal name
PMG OPCO-COLONIAL LLC
Doing business as
COLONIAL OAKS SKILLED NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 24, 2004
Last certification
Jun 5, 2025
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Priority
Most recent change of ownership
Apr 1, 2019
Organization structure
LLCProprietary
Enrollment address
4921 Medical Dr
Bossier City, LA 71112-4522
Nursing home name
COLONIAL OAKS SKILLED NURSING AND REHABILITATION
Affiliated entity
PRIORITY MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Colonial Oaks Skilled Nursing and RehabilitationCCN 195604
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Sep 24, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12085.8 residents per day on average
Chain
Priority Management38 facilities in the chain
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $66,170

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
19D0670034Colonial Oaks Skilled Nursing & Rehabilitation4921 Medical Drive, Bossier City, LA 71112Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

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%
Indirect Ownership Interest Apr 1, 2019 33.34%
Organization, Lake Charles, LA LLC Adp of the SNF Apr 16, 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
Individual Adp of the SNF Apr 1, 2019
Priority Management Group, LLC Organization, Bossier City, LA LLC, Management services company, Chain home office Operational/Managerial Control Apr 1, 2019 100%
Adp of the SNF Apr 16, 2025
David Colvin Individual Adp of the SNF May 27, 2025
Individual Adp of the SNF Apr 1, 2019
Steven D Boulware Individual 5% Or Greater Indirect Ownership InterestManaging Member of MGMT Company Apr 1, 2019 33.33%
Operational/Managerial ControlManaging Member Apr 1, 2019 33.33%
Indirect Ownership Interest Apr 1, 2019 33.33%
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%
Rukiya Lewis Individual Adp of the SNF Sep 19, 2018
Organization, Bossier City, LA LLC Adp of the SNF Apr 16, 2025
Jamie Copeland Individual Adp of the SNF Apr 16, 2025
Progressive Rehab Solutions, LLC Organization, Dallas, TX LLC Operational/Managerial Control Apr 1, 2019
Organization, Bossier City, LA LLC Adp of the SNF Apr 16, 2025
Individual Adp of the SNF Apr 1, 2019
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, Lake Charles, LA LLC Adp of the SNF Apr 16, 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 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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": "1553731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1124589544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 MEDICAL DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124522",
            "telephone_number": "318-742-5420",
            "fax_number": "318-742-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 MEDICAL DR",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124522",
            "telephone_number": "318-742-5420",
            "fax_number": "318-742-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMG OPCO-COLONIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-28",
        "last_updated": "2019-03-28",
        "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": "COLONIAL OAKS SKILLED NURSING AND REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.