NPIMap

Organization Active NPI

Grand Manor Health Care Center, L.L.C.

Doing business as Grand Manor Health Care Center

  • Skilled Nursing Facility
  • Saint Louis, MO
National Provider Identifier
1215782149
Registry record updated Feb 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
GRAND MANOR HEALTH CARE CENTER, L.L.C.
Doing business as
Grand Manor Health Care Center
Practice address
3645 Cook Ave
Saint Louis, MO 63113-3801
Phone
(314) 531-2352
Fax
(314) 531-2352
NPI assigned
Apr 23, 2024
Last updated
Feb 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2026

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

Authorized official

Name
Mr. Richard J. Destefane
Title
President
Phone
(314) 543-3816

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

3645 Cook Ave
Saint Louis, MO 63113-3801

Mailing address

1869 Craig Park CT
Saint Louis, MO 63146-4122
Phone (314) 543-3816

Other names 1

  • Grand Manor 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
O20241115002740 MO Part A Provider - Skilled Nursing Facility 6709322084 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215782149. Details of each certification follow.

Skilled nursing facility certification: CCN 265717

Legal name
GRAND MANOR HEALTH CARE CENTER LLC
Doing business as
GRAND MANOR HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 18, 2000
Last certification
Sep 13, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
May 1, 2024
Organization structure
LLCProprietary
Enrollment address
3645 Cook Ave
Saint Louis, MO 63113-3801
Nursing home name
GRAND MANOR HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Grand Manor Health Care CenterCCN 265717 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Dec 18, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120107.6 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Penalties (3 years)
2Fines totaling $126,118

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
RCG Inc Organization, Saint Louis, MO Corporation, Holding company Adp of the SNF Dec 10, 2024
Richard J. Destefane Revocable Living Trust Organization, Saint Louis, MO 5% Or Greater Indirect Ownership Interest May 1, 2024 100%
Richard J Destefane Individual 5% Or Greater Indirect Ownership InterestPresident May 1, 2024 100%
Corporate OfficerPresident May 1, 2024
Reliant Care Group LLC Organization, Saint Louis, MO LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 1, 2024 100%
TLG II LLP Organization, Saint Louis, MO Holding company Adp of the SNF Dec 10, 2024
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC, Management services company Operational/Managerial Control Dec 10, 2024
Abdullah Arshad Individual Contracted Managing EmployeeMD; May 1, 2024
Grand Manor Associates LLC Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest May 1, 2024 100%
Reliant Care Group of Webster Inc Organization, Saint Louis, MO Corporation, Holding company Adp of the SNF Dec 10, 2024
Robin Allen Individual W-2 Managing EmployeeAd; May 1, 2024 100%

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 33

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

View all 33

Practitioners & affiliated clinicians

Practitioners 5

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": "1713830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771545600000",
    "number": "1215782149",
    "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": "314-543-3816",
            "fax_number": "314-226-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3645 COOK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631133801",
            "telephone_number": "314-531-2352",
            "fax_number": "314-531-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND MANOR HEALTH CARE CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-23",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "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": "314-543-3816",
        "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": "Grand Manor Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.