Provider Demographics
NPI:1790222693
Name:PDM OPERATORS LLC
Entity Type:Organization
Organization Name:PDM OPERATORS LLC
Other - Org Name:ARBOR GRACE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-812-2140
Mailing Address - Street 1:101 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3266
Mailing Address - Country:US
Mailing Address - Phone:318-812-2140
Mailing Address - Fax:318-812-2143
Practice Address - Street 1:1241 W MARSHALL HOWARD BLVD
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-5951
Practice Address - Country:US
Practice Address - Phone:806-385-6600
Practice Address - Fax:806-385-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility