MEDICARE: FHS PINE GROVE, INC.

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	1405N	OH

General Provider Information

NPI Number	:	1538658489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FHS PINE GROVE, INC.

Provider Business Mailing Address
First Line	:	25000 COUNTRY CLUB BLVD STE 255
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5337
Country	:	US
Telephone Number	:	440-614-0160
Fax Number	:	440-614-0168

Provider Business Practice Location Address
First Line	:	840 SHERMAN ST
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9101
Country	:	US
Telephone Number	:	440-415-0502
Fax Number	:	440-415-0504

Authorized Official
Title or Position	:	CORPORATE SECRETARY
Name	:	SANDY MUIR
Credential	:
Telephone Number	:	440-793-2245

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	06/02/2026

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Directions to “FHS PINE GROVE, INC. ” Practice Location

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