Provider Demographics
NPI:1124884481
Name:PMG OPCO-ALLEN LLC
Entity type:Organization
Organization Name:PMG OPCO-ALLEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-428-0880
Mailing Address - Street 1:310 S JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3039
Mailing Address - Country:US
Mailing Address - Phone:972-727-5850
Mailing Address - Fax:972-727-5625
Practice Address - Street 1:310 S JUPITER RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3039
Practice Address - Country:US
Practice Address - Phone:972-727-5850
Practice Address - Fax:972-727-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility