NPIMap

Organization Active NPI

The Estates of Spanish Lake, LLC

Doing business as The Estates of Spanish Lake

  • Skilled Nursing Facility
  • Saint Louis, MO
National Provider Identifier
1053715995
Registry record updated Mar 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE ESTATES OF SPANISH LAKE, LLC
Doing business as
The Estates of Spanish Lake
Practice address
610 Prigge Rd
Saint Louis, MO 63138-3543
Phone
(610) 828-8700
NPI assigned
Oct 21, 2014
Last updated
Mar 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tuviyah Spector
Title
Managing Member
Phone
(773) 322-0387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

610 Prigge Rd
Saint Louis, MO 63138-3543

Mailing address

5940 W Touhy Ave
Ste 350
Niles, IL 60714-4638

Other names 1

  • The Estates of Spanish Lake Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160317000166 MO Part A Provider - Skilled Nursing Facility 2769788702 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053715995. Details of each certification follow.

Skilled nursing facility certification: CCN 265776

Legal name
THE ESTATES OF SPANISH LAKE, LLC
Doing business as
THE ESTATES OF SPANISH LAKE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 19, 2004
Last certification
Apr 25, 2025
Beds
150
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Mar 1, 2016
Organization structure
LLCProprietary
Enrollment address
610 Prigge Rd
Saint Louis, MO 63138-3543
Nursing home name
ESTATES OF SPANISH LAKE, THE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Estates of Spanish Lake, theCCN 265776 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 19, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150140.3 residents per day on average
Penalties (3 years)
4Fines totaling $57,868

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Zev Rosenberg Individual 5% Or Greater Direct Ownership Interest Sep 10, 2014 60%
Operational/Managerial Control Sep 10, 2014
Adp of the SNF Sep 10, 2014
Organization, Chicago, IL Corporation Adp of the SNF Jun 26, 2025
Shawn Michael Gao Individual Operational/Managerial Control May 1, 2019
Adp of the SNF May 1, 2019
Katrina Hawkins Individual Operational/Managerial Control Feb 4, 2025
Adp of the SNF Feb 4, 2025
Medallion Healthcare Systems LLC Organization, Niles, IL LLC, Management services company Adp of the SNF Sep 10, 2014
Organization, Irving, TX LLC, Medical staffing company Adp of the SNF Jun 30, 2025
Tuviyah Spector Individual Operational/Managerial Control Sep 10, 2014
Adp of the SNF Sep 10, 2014
Direct Ownership Interest Sep 10, 2014 40%
Organization, Plano, TX LLC Adp of the SNF Jun 30, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457481600000",
    "number": "1053715995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 W TOUHY AVE",
            "address_2": "STE 350",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 PRIGGE RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631383543",
            "telephone_number": "610-828-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ESTATES OF SPANISH LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2016-03-09",
        "status": "A",
        "authorized_official_last_name": "SPECTOR",
        "authorized_official_first_name": "TUVIYAH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "773-322-0387"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Estates of Spanish Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.