NPIMap

Organization Active NPI

Pine Grove Manor LLC

Doing business as Pine Grove Manor

  • Skilled Nursing Facility
  • Saint Louis, MO
National Provider Identifier
1548061310
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PINE GROVE MANOR LLC
Doing business as
Pine Grove Manor
Practice address
4359 Taft Ave
Saint Louis, MO 63116-1533
Phone
(314) 752-2022
NPI assigned
Mar 19, 2025
Last updated
Mar 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Authorized official

Name
Mr. David Garetz
Title
Cfo
Phone
(323) 987-5954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

4359 Taft Ave
Saint Louis, MO 63116-1533

Mailing address

4359 Taft Ave
Saint Louis, MO 63116-1533

Other names 1

  • Pine Grove Manor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250604001377 MO Part A Provider - Skilled Nursing Facility 8527577147 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548061310. Details of each certification follow.

Skilled nursing facility certification: CCN 265828

Legal name
PINE GROVE MANOR LLC
Doing business as
PINE GROVE MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 1, 2009
Last certification
Apr 3, 2024
Beds
77
Ownership / control type
Corporation
Multi-facility organization
Opco
Organization structure
LLCProprietary
Enrollment address
4359 Taft Ave
Saint Louis, MO 63116-1533
Nursing home name
PINE GROVE MANOR
Affiliated entity
OPCO SKILLED MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pine Grove ManorCCN 265828 · 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 - Corporation
Certified
May 1, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7751.9 residents per day on average
Chain
Opco Skilled Management66 facilities in the chain
Penalties (3 years)
3Fines totaling $31,665

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

4359 Taft Ave
Saint Louis, MO 63116
Phone (314) 752-2022

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Individual Adp of the SNF Jun 14, 2018
Esdov Investments LLC Organization, Los Angeles, CA LLC, Holding company Adp of the SNF Aug 11, 2025
First Sweetzer Holdings LLC Organization, Los Angeles, CA LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest May 1, 2025 1%
Bankwell Bank Organization, New Canaan, CT Corporation, Financial institution 5% Or Greater Security Interest May 1, 2025 80%
Individual Adp of the SNF Jul 1, 2023
Solomon L Gurwitz Individual Direct Ownership Interest Mar 1, 2024 100%
Herald Advisors LLC Organization, Los Angeles, CA LLC, Holding company Adp of the SNF Aug 11, 2025
Opco Ca Skilled MGMT Inc. Organization, Los Angeles, CA Corporation, Consulting firm Operational/Managerial Control Mar 1, 2024
Adp of the SNF Mar 1, 2024
Sasem Investments LLC Organization, Los Angeles, CA LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest May 1, 2025 3.2%
Jeffrey Unger Individual Operational/Managerial Control May 1, 2025
Mark Brencick Individual Operational/Managerial Control May 1, 2025
Adp of the SNF Aug 11, 2025
Lucent Advisors LLC Organization, Los Angeles, CA LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest May 1, 2025 99%
Rimpau Holdings Trust Organization, Los Angeles, CA Indirect Ownership Interest May 1, 2025 34.49%
Amber HC Trust Organization, Los Angeles, CA Indirect Ownership Interest May 1, 2025 61.31%
Arches Healthcare LLC Organization, Los Angeles, CA Investment firm, Owned by another organization or individual Direct Ownership Interest May 1, 2025 100%
Niv Davidovich Individual Trustee of the SNF May 1, 2025
Melanie Littlefield-Lea Individual Operational/Managerial Control May 1, 2025
Shawn Michael Gao Individual Operational/Managerial Control May 1, 2025
Adp of the SNF Aug 11, 2025
Tuscany HC Trust Organization, Los Angeles, CA Adp of the SNF Aug 11, 2025
4359 Taft Ave Mo LLC Organization, Los Angeles, CA LLC Adp of the SNF May 1, 2025
Esther Kaplan Individual Operational/Managerial Control May 1, 2025
Indirect Ownership Interest May 1, 2025 3.2%
Forvis Mazars LLP Organization, Springfield, MO Consulting firm Operational/Managerial Control Jun 1, 2023
Adp of the SNF Jun 1, 2023
Linz Trust Organization, Los Angeles, CA Adp of the SNF Aug 11, 2025
Pease Bell Cpas LLC Organization, Cleveland, OH LLC, Consulting firm Operational/Managerial Control Jun 14, 2018
Adp of the SNF Jun 14, 2018
Jennifer Sternshein Individual Trustee of the SNF May 1, 2025
David Garetz Individual Operational/Managerial Control May 1, 2025
Indirect Ownership Interest May 1, 2025 1%
Mizzou Realty Investors LLC Organization, Los Angeles, CA LLC Adp of the SNF Aug 11, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 88

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 88

Practitioners & affiliated clinicians

Practitioners 1

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 1

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": "1742342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1548061310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4359 TAFT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631161533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4359 TAFT AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631161533",
            "telephone_number": "314-752-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE GROVE MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-19",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "GARETZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "323-987-5954",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Grove Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.