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NPI Code Detail

MEDICARE: COUNTRY VILLA WELLNESS & REHABILITATION LLC

MEDICARE: COUNTRY VILLA 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1881552982
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTRY VILLA WELLNESS & REHABILITATION LLC
Provider Business Mailing Address
First Line : 850 COUNTRY MANOR LN
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-6651
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 850 COUNTRY MANOR LN
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-6651
Country : US
Telephone Number : 323-987-5954
Fax Number :
Authorized Official
Title or Position : CFO
Name : DAVID GARETZ
Credential :
Telephone Number : 213-395-1848
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “COUNTRY VILLA WELLNESS & REHABILITATION LLC ” Practice Location

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