NPIMap

Organization Active NPI

PMG Opco-Springlake LLC

Doing business as Spring Lake Skilled Nursing and Rehabilitation

  • Skilled Nursing Facility
  • Shreveport, LA
National Provider Identifier
1992266316
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-SPRINGLAKE LLC
Doing business as
Spring Lake Skilled Nursing and Rehabilitation
Practice address
8622 Line Ave
Shreveport, LA 71106-6108
Phone
(318) 868-4126
Fax
(318) 868-9084
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

8622 Line Ave
Shreveport, LA 71106-6108

Mailing address

8622 Line Ave
Shreveport, LA 71106-6108
Phone (318) 868-4126

Other names 1

  • SPRING LAKE 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
O20190425000544 LA Part A Provider - Skilled Nursing Facility 7113269044 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992266316. Details of each certification follow.

Skilled nursing facility certification: CCN 195344

Legal name
PMG OPCO-SPRINGLAKE LLC
Doing business as
SPRING LAKE SKILLED NURSING AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jul 1, 1995
Last certification
Sep 25, 2024
Beds
160
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
8622 Line Avenue
Shreveport, LA 71106-6108
Nursing home name
SPRING LAKE SKILLED NURSING AND REHABILITATION
Affiliated entity
PRIORITY MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Spring Lake Skilled Nursing and RehabilitationCCN 195344 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
160120.4 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
19D0673760Spring Lake Skilled Nursing and Rehabilitation8622 Line Avenue, Shreveport, LA 71106Certificate of waiverAug 31, 2026

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.

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 Interest33.34% Via SDB Holdings Apr 1, 2019 33.34%
Indirect Ownership Interest Apr 1, 2019 33.34%
Individual Adp of the SNF Apr 1, 2019
Organization, Bossier City, LA LLC Adp of the SNF Jul 2, 2025
Organization, Bossier City, LA LLC, Consulting firm Adp of the SNF Jul 2, 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 Jul 2, 2025
David Colvin Individual Adp of the SNF Jul 2, 2025
Organization, Lake Charles, LA LLC Adp of the SNF Jul 2, 2025
Steven D Boulware Individual 5% Or Greater Indirect Ownership Interest33.33% Via SDB Holdings Apr 1, 2019 33.33%
Operational/Managerial ControlAuthorized Official & Managing M Apr 1, 2019 3.33%
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%
Individual Adp of the SNF Apr 1, 2019
Organization, Lake Charles, LA LLC Adp of the SNF Jul 2, 2025
Individual Adp of the SNF Apr 1, 2019
Charles L Lebon Individual Adp of the SNF Apr 18, 2025
Progressive Rehab Solutions, LLC Organization, Dallas, TX LLC Adp of the SNF Apr 1, 2019
Latonya E Greggs Individual Adp of the SNF Jul 26, 2021
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
William M Bauder Individual 5% Or Greater Indirect Ownership Interest33.33% Via SDB Holdings Apr 1, 2019 33.33%
Operational/Managerial ControlManaging Member Apr 1, 2019 33.33%
Indirect Ownership Interest 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 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": "1992266316",
    "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",
            "telephone_number": "318-868-4126",
            "fax_number": "318-868-9084"
        },
        {
            "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": "318-868-4126",
            "fax_number": "318-868-9084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PMG OPCO-SPRINGLAKE 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": "SPRING LAKE 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.