Hidden Lake Health Care Center, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

HIDDEN LAKE HEALTH CARE CENTER, LLC

Practice address

11728 Hidden Lake Dr
Saint Louis, MO 63138-1765

Phone

(314) 355-8833

NPI assigned

Jul 9, 2025

Organization subpart

No

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

Authorized official

Name

Richard J. Destefane

Title

President

Phone

(314) 543-3805

Specialties & licenses 1

Addresses

Other names 1

• Hidden Lake Health Care Center Doing business as

Tax ID family

Hidden Lake Health Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Hidden Lake Health Care Center LLC

  • Skilled Nursing Facility
  • Saint Louis, MO
  • NPI 1376433342
  NPD tax ID

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

{
    "created_epoch": "1752019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757635200000",
    "number": "1104716190",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11728 HIDDEN LAKE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631381765",
            "telephone_number": "314-355-8833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN LAKE HEALTH CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-09",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A",
        "authorized_official_last_name": "DESTEFANE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-543-3805"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Lake Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jane A Hicks, PNP
• Judy Hicks
• Teresa Hicks
• Hidden Lake Al Opco LLC
• Hidden Lake Health Care Center LLC
• Hidden Lake Opco LLC
• Suhail Hiermandi, DO
• Madeline Lucille Hieser, CF-SLP
• Shay C Hietpas, PA-C
• Stuart Taylor Higano, M.D.

• All providers in Saint Louis, MO
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.