MEDICARE: PINE GROVE MANOR 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	:	1548061310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE GROVE MANOR LLC

Provider Business Mailing Address
First Line	:	4359 TAFT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-1533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4359 TAFT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-1533
Country	:	US
Telephone Number	:	314-752-2022
Fax Number	:

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

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

Similar Medicare Providers

1922007277 — R. DEVELOPMENT, INC
Practice Location Address:

4359 TAFT AVE
SAINT LOUIS, MO
63116-1533

Practice Phone: 314-752-2022
Practice Fax: 314-752-7679

1942450879 — JPAM MANAGEMENT & CONSULTING INC
Practice Location Address:

4359 TAFT AVE
SAINT LOUIS, MO
63116-1533

Practice Phone: 314-752-2022
Practice Fax:

1528677887 — CALLIE MAE MATHIS
Practice Location Address:

4359 TAFT AVE
SAINT LOUIS, MO
63116-1533

Practice Phone: 314-752-2022
Practice Fax:

1215083480 — ELAINE J. TOON LPC
Practice Location Address:

5131 LEMAY FERRY RD
SAINT LOUIS, MO
63129-1533

Practice Phone: 314-971-0990
Practice Fax: 314-200-9744

1730212119 — TRACY SCHAMBURG LPC
Practice Location Address:

5127 LEMAY FERRY RD
SAINT LOUIS, MO
63129-1533

Practice Phone: 314-487-5127
Practice Fax:

1033323175 — MR. JUDY SUSAN PECKHAM LPC
Practice Location Address:

5127 LEMAY FERRY RD
SAINT LOUIS, MO
63129-1533

Practice Phone: 314-487-5127
Practice Fax: 314-487-5127

Directions to “PINE GROVE MANOR LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.