NPIMap

Organization Active NPI

Mma Healthcare of St. Elizabeth, Inc.

  • Skilled Nursing Facility
  • St. Elizabeth, MO
National Provider Identifier
1306028261
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
038104 Issued in MO
Legal business name
MMA HEALTHCARE OF ST. ELIZABETH, INC.
Practice address
649 S Walnut Street
St. Elizabeth, MO 65075-2440
Phone
(573) 493-2215
Fax
(573) 493-2712
NPI assigned
Dec 3, 2007
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
Skilled Nursing Facility 314000000X 034857 MO
Skilled Nursing Facility 314000000X 038104 MO Primary

Addresses

Primary practice location

649 S Walnut Street
St. Elizabeth, MO 65075-2440

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
101477305MedicaidMO

Other names 1

  • St. Elizabeth 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
O20080328000390 MO Part A Provider - Skilled Nursing Facility 3476639584 Practice locations: St Elizabeth, MO

Skilled nursing facility certification: CCN 265676

Legal name
MMA HEALTHCARE OF ST ELIZABETH INC
Doing business as
ST. ELIZABETH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1997
Last certification
Feb 6, 2025
Beds
63
Ownership / control type
Corporation
Multi-facility organization
RELIANT CARE MANAGEMENT COMPANY
Most recent change of ownership
Oct 1, 2007
Organization structure
CorporationProprietary
Incorporated
Aug 24, 2007 in MO
Enrollment address
649 S Walnut St
St Elizabeth, MO 65075-2440
Nursing home name
ST ELIZABETH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
St Elizabeth Care CenterCCN 265676
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6359.2 residents per day on average
Chain
Reliant Care Management34 facilities in the chain

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
Brandy Kaus Individual W-2 Managing EmployeeAdministrator Aug 3, 2018 100%
Richard J Destefane Individual Corporate OfficerPresident Oct 1, 2010 100%
Corporate DirectorPresident Oct 1, 2010 100%
Richard J Destefane Revocable Living Trust Organization, Saint Louis, MO 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC Operational/Managerial Control Apr 2, 2013

Facilities with the same owner 32

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

View all 32

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1306028261",
    "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": "649 S WALNUT STREET",
            "city": "ST. ELIZABETH",
            "state": "MO",
            "postal_code": "650752440",
            "telephone_number": "573-493-2215",
            "fax_number": "573-493-2712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMA HEALTHCARE OF ST. ELIZABETH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-03",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "034857",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "038104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101477305",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Elizabeth Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St. Elizabeth, MO

Sources for this page

Verify at the official NPI Registry.