NPIMap

Organization Active NPI

Crestwood Health Care Center, L.L.C.

Doing business as Crestwood Health Care Center

  • Nursing Facility/Intermediate Care Facility
  • Florissant, MO
National Provider Identifier
1083882682
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
038173 Issued in MO
Legal business name
CRESTWOOD HEALTH CARE CENTER, L.L.C.
Doing business as
Crestwood Health Care Center
Practice address
11400 Mehl Avenue
Florissant, MO 63033-7204
Phone
(314) 741-3525
Fax
(314) 741-3721
NPI assigned
Feb 15, 2008
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Mr. Ashwin Dundoo
Title
Finance
Phone
(314) 543-3800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X
Nursing Facility/Intermediate Care Facility 313M00000X 038173 MO Primary

Addresses

Primary practice location

11400 Mehl Avenue
Florissant, MO 63033-7204

Mailing address

1869 Craig Park CT
Saint Louis, MO 63146-4122
Phone (314) 543-3800

Other identifiers 1

IdentifierTypeStateIssuer
102504701MedicaidMO

Other names 1

  • Crestwood Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080826000478 MO Part A Provider - Skilled Nursing Facility 4981779923 Practice locations: Florissant, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083882682. Details of each certification follow.

Skilled nursing facility certification: CCN 265823

Legal name
CRESTWOOD HEALTH CARE CENTER, L.L.C.
Doing business as
CRESTWOOD HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 2008
Last certification
Jun 21, 2024
Beds
150
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Feb 14, 2008 in MO
Enrollment address
11400 Mehl Ave
Florissant, MO 63033-7204
Nursing home name
CRESTWOOD HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crestwood Health Care CenterCCN 265823 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150139.2 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
3Fines totaling $146,887

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Richard J Destefane Individual 5% Or Greater Indirect Ownership Interest Feb 14, 2008 99.99%
Corporate OfficerPresident Jan 1, 2008 100%
Reliant Care Group LLC Organization, St Louis, MO LLC 5% Or Greater Direct Ownership Interest Feb 14, 2008 100%
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC Operational/Managerial Control Feb 14, 2008
Chad Culp Individual W-2 Managing EmployeeAdministrator Jan 20, 2022 100%

Facilities with the same owner 33

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

View all 33

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1083882682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1869 CRAIG PARK CT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464122",
            "telephone_number": "314-543-3800",
            "fax_number": "314-543-3880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 MEHL AVENUE",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630337204",
            "telephone_number": "314-741-3525",
            "fax_number": "314-741-3721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD HEALTH CARE CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-15",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "DUNDOO",
        "authorized_official_first_name": "ASHWIN",
        "authorized_official_title_or_position": "FINANCE",
        "authorized_official_telephone_number": "314-543-3800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MO",
            "license": "038173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102504701",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestwood Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florissant, MO

Sources for this page

Verify at the official NPI Registry.