NPIMap

Organization Active NPI

PMG Opco-Bradford LLC

Doing business as The Bradford Skilled Nursing and Rehabilitation

  • Skilled Nursing Facility
  • Shreveport, LA
National Provider Identifier
1952862377
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-BRADFORD LLC
Doing business as
The Bradford Skilled Nursing and Rehabilitation
Practice address
3050 Baird Rd
Shreveport, LA 71118-3818
Phone
(318) 688-1010
Fax
(318) 688-1099
NPI assigned
Mar 28, 2019
Last updated
Mar 28, 2019By the provider in NPPES
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

3050 Baird Rd
Shreveport, LA 71118-3818

Mailing address

3050 Baird Rd
Shreveport, LA 71118-3818
Phone (318) 688-1010

Other names 1

  • THE BRADFORD 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
O20190510000057 LA Part A Provider - Skilled Nursing Facility 0143563379 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952862377. Details of each certification follow.

Skilled nursing facility certification: CCN 195513

Legal name
PMG OPCO-BRADFORD LLC
Doing business as
THE BRADFORD SKILLED NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jan 12, 2001
Last certification
Aug 22, 2024
Beds
146
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Priority Management LLC
Organization structure
LLCProprietary
Enrollment address
3050 Baird Rd
Shreveport, LA 71118-3818
Nursing home name
THE BRADFORD SKILLED NURSING AND REHABILITATION
Affiliated entity
PRIORITY MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Bradford Skilled Nursing and RehabilitationCCN 195513 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 12, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
146100.1 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
19D0673474Bradford Skilled Nursing & Rehabilitation, the3050 Baird Road, Shreveport, LA 71118Certificate 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%
Individual Adp of the SNF Apr 1, 2019
Organization, Lake Charles, LA LLC Adp of the SNF Apr 15, 2025
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 15, 2025
Organization, Lake Charles, LA LLC Adp of the SNF Apr 15, 2025
Individual Adp of the SNF Apr 1, 2019
Stephen D Peterson Individual Adp of the SNF Apr 16, 2025
Organization, San Clemente, CA Adp of the SNF Apr 1, 2019
Tamara P Grimm Individual Adp of the SNF Sep 19, 2018
David Colvin Individual Adp of the SNF Apr 15, 2025
Organization, San Clemente, CA Corporation, Real estate investment trust (REIT) 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%
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%
Organization, Bossier City, LA LLC Adp of the SNF Apr 15, 2025
Individual Adp of the SNF Apr 1, 2019
Progressive Rehab Solutions, LLC Organization, Dallas, TX LLC Adp of the SNF Apr 1, 2019
Organization, Bossier City, LA LLC Adp of the SNF Apr 15, 2025
William M Bauder Individual 5% Or Greater Indirect Ownership InterestManaging Member of MGMT Company Apr 1, 2019 33.33%

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 2

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": "1553731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1952862377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 BAIRD RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183818",
            "telephone_number": "318-688-1010",
            "fax_number": "318-688-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 BAIRD RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183818",
            "telephone_number": "318-688-1010",
            "fax_number": "318-688-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMG OPCO-BRADFORD 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": "THE BRADFORD SKILLED NURSING AND REHABILITATION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.