MEDICARE: MAPLE GROVE WELLNESS & REHABILITATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1861231698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE GROVE WELLNESS & REHABILITATION LLC

Provider Business Mailing Address
First Line	:	560 CORISANDE HILL RD
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-5613
Country	:	US
Telephone Number	:	636-343-2282
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 CORISANDE HILL RD
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-5613
Country	:	US
Telephone Number	:	636-343-2282
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	DAVID GARETZ
Credential	:
Telephone Number	:	323-987-5954

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	07/07/2024

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Directions to “MAPLE GROVE WELLNESS & REHABILITATION LLC ” Practice Location

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