Mma Healthcare of Viburnum, Inc.
Organization Active NPI Skilled Nursing Facility · Viburnum, MO
NPI 1366499196 · NPPES record last updated Nov 8, 2019
Key facts
- NPI
- 1366499196
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 038104 (MO)
- Legal business name
- MMA HEALTHCARE OF VIBURNUM, INC.
- Practice address
- 2 Highway Y
Viburnum, MO 65566-9701 - Phone
- (573) 244-3171
- Fax
- (573) 244-3112
- NPI assigned
- May 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Richard J. Destefane
- Title
- President
- Phone
- (314) 543-3816
Owners & managing parties with NPI records 1
-
Abdullah Arshad, MD
Facilities with the same owner 32
Practitioners 3
-
Naser Almasalmeh, M.D.
-
Abdullah Arshad, MD
Affiliated clinicians 1
-
Naser Almasalmeh, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Stonecrest Healthcare
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jul 5, 1994
- Medicare certification status
- Active
- Certified beds
- 60 · 55.7 residents per day on average
- Chain
- Reliant Care Management
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265582
- Legal name
- MMA HEALTHCARE OF VIBURNUM INC
- Doing business as
- STONECREST HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 5, 1994
- Last certification
- Mar 29, 2024
- Beds
- 60
- Ownership / control type
- Corporation
- Multi-facility organization
- RELIANT CARE MANAGEMENT
- Organization structure
- Corporation · Proprietary
- Incorporated
- Dec 22, 2005 in MO
- Enrollment address
- 2 Highway Y
# 707
Viburnum, MO 65566-8644 - Nursing home name
- STONECREST HEALTHCARE
- Affiliated entity
- RELIANT CARE MANAGEMENT
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Richard J. Destefane Revocable Living Trust |
5% Or Greater Indirect Ownership Interest | Mar 1, 2018 | 100% |
| Adp of the SNF | Mar 1, 2018 | ||
| Richard J Destefane |
5% Or Greater Indirect Ownership Interest |
Mar 1, 2018 | 100% |
| Corporate Officer |
Oct 1, 2010 | 100% | |
| Operational/Managerial Control | Oct 1, 2010 | ||
| Adp of the SNF | Mar 1, 2018 | ||
| TLG II LLP |
Adp of the SNF | Oct 1, 2010 | |
| Reliant Care Management Company LLC |
Operational/Managerial Control | Oct 1, 2010 | |
| Adp of the SNF | May 13, 2025 | ||
| Julia Greene |
Operational/Managerial Control | Nov 27, 2024 | |
| Adp of the SNF | Nov 27, 2024 | ||
| Abdullah Arshad |
Operational/Managerial Control | Sep 15, 2024 | |
| Adp of the SNF | Sep 15, 2024 | ||
| Bky Properties Viburnum LLC |
Adp of the SNF | Oct 1, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060905000553 | MO | Part a Provider - Skilled Nursing Facility | 7911901996 | Practice locations: Viburnum, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 032452 | MO | |
| Skilled Nursing Facility | 314000000X | 038104 | MO | Yes |
Addresses
Primary practice location
2 Highway Y
Viburnum, MO 65566-9701
Mailing address
1869 Craig Park CT
Saint Louis, MO 63146-4122
Phone (314) 543-3800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103060604 | Medicaid | MO |
Other names
- Stonecrest Healthcare
Other providers in Viburnum, MO
- Disabled Citizens Alliance for Independence
- Disabled Citizens Alliance for Independence Foundation, Inc
- Iron County C-4 School District
- Iron County EMS
- Lester E Cox Medical Centers
- Theodore Joshua Olbricht
- Deana Payne
- Linda Sue Pyatt
- Vanessa R Roper
- Stonecrest SNF Opco LLC
All providers in Viburnum, MO · Skilled Nursing Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.