Provider Demographics
NPI:1699147694
Name:PRIORITY GROUP HOLDINGS, L.L.C.
Entity type:Organization
Organization Name:PRIORITY GROUP HOLDINGS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOULWARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-658-9978
Mailing Address - Street 1:4502 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3531
Mailing Address - Country:US
Mailing Address - Phone:504-361-7923
Mailing Address - Fax:504-368-4807
Practice Address - Street 1:4502 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3531
Practice Address - Country:US
Practice Address - Phone:504-361-7923
Practice Address - Fax:504-368-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203782578OtherDHH LICENSE
LA2203782578OtherDHH LICENSE