NPIMap

Organization Active NPI

Mma Healthcare of Viburnum, Inc.

Doing business as Stonecrest Healthcare

  • Skilled Nursing Facility
  • Viburnum, MO
National Provider Identifier
1366499196
Registry record updated Nov 8, 2019
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 VIBURNUM, INC.
Doing business as
Stonecrest Healthcare
Practice address
2 Highway Y
Viburnum, MO 65566-9701
Phone
(573) 244-3171
Fax
(573) 244-3112
NPI assigned
May 27, 2006
Last updated
Nov 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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) 543-3816

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 032452 MO
Skilled Nursing Facility 314000000X 038104 MO Primary

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 names 1

  • Stonecrest Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060905000553 MO Part A Provider - Skilled Nursing Facility 7911901996 Practice locations: Viburnum, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366499196. Details of each certification follow.

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
CorporationProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Stonecrest HealthcareCCN 265582 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
6055.7 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 7

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 Revocable Living Trust Organization, Saint Louis, MO 5% Or Greater Indirect Ownership Interest Mar 1, 2018 100%
Adp of the SNF Mar 1, 2018
Richard J Destefane Individual 5% Or Greater Indirect Ownership InterestPresident Mar 1, 2018 100%
Corporate OfficerPresident Oct 1, 2010 100%
Operational/Managerial Control Oct 1, 2010
Adp of the SNF Mar 1, 2018
TLG II LLP Organization, Saint Louis, MO Holding company Adp of the SNF Oct 1, 2010
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC, Management services company, Chain home office Operational/Managerial Control Oct 1, 2010
Adp of the SNF May 13, 2025
Julia Greene Individual Operational/Managerial Control Nov 27, 2024
Adp of the SNF Nov 27, 2024
Abdullah Arshad Individual Operational/Managerial Control Sep 15, 2024
Adp of the SNF Sep 15, 2024
Bky Properties Viburnum LLC Organization, Saint Louis, MO LLC Adp of the SNF Oct 1, 2010

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 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, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1366499196",
    "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": "2 HIGHWAY Y",
            "city": "VIBURNUM",
            "state": "MO",
            "postal_code": "655669701",
            "telephone_number": "573-244-3171",
            "fax_number": "573-244-3112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMA HEALTHCARE OF VIBURNUM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2019-11-08",
        "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"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "032452",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "038104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stonecrest Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stonecrest Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Viburnum, MO

Sources for this page

Verify at the official NPI Registry.