NPIMap

Organization Active NPI

Hidden Lake Health Care Center LLC

Doing business as Hidden Lake Health Care Center

  • Skilled Nursing Facility
  • Saint Louis, MO
National Provider Identifier
1376433342
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HIDDEN LAKE HEALTH CARE CENTER LLC
Doing business as
Hidden Lake Health Care Center
Practice address
11728 Hidden Lake Dr
Saint Louis, MO 63138-1765
Phone
(314) 355-8833
NPI assigned
Jul 9, 2025
Last updated
Oct 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

11728 Hidden Lake Dr
Saint Louis, MO 63138-1765

Mailing address

1869 Craig Park CT
Saint Louis, MO 63146-4122

Other names 1

  • Hidden Lake 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
O20251017001983 MO Part A Provider - Skilled Nursing Facility 3870080211 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376433342. Details of each certification follow.

Skilled nursing facility certification: CCN 265735

Legal name
HIDDEN LAKE HEALTH CARE CENTER, LLC
Doing business as
HIDDEN LAKE HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 26, 2002
Last certification
Aug 19, 2024
Beds
67
Ownership / control type
Limited Liability Corporation
Multi-facility organization
EXTENDED CARE LLC
Most recent change of ownership
Aug 1, 2025
Organization structure
LLCProprietary
Enrollment address
11728 Hidden Lake Dr
Saint Louis, MO 63138-1765
Nursing home name
HIDDEN LAKE HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Hidden Lake Health Care CenterCCN 265735 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 26, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6750.2 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Penalties (3 years)
3Fines totaling $123,610
Ownership change
Changed ownership in the last 12 months

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
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.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Harold Lutz Individual Operational/Managerial Control Oct 20, 2025
Adp of the SNF Oct 20, 2025
RCG Inc Organization, Saint Louis, MO Corporation, Holding company, Owned by another organization or individual Indirect Ownership Interest Aug 1, 2025 0.01%
Richard J. Destefane Revocable Living Trust Organization, Saint Louis, MO Indirect Ownership Interest Aug 1, 2025 100%
Richard J Destefane Individual Operational/Managerial Control Aug 1, 2025
Indirect Ownership Interest Aug 1, 2025 100%
Reliant Care Group LLC Organization, Saint Louis, MO LLC, Holding company Direct Ownership Interest Aug 1, 2025 100%
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC, Management services company, Chain home office Operational/Managerial Control Aug 1, 2025
Adp of the SNF Aug 6, 2025
Abdullah Arshad Individual Operational/Managerial Control Aug 1, 2025
Adp of the SNF Aug 1, 2025
HL Property, LLC Organization, Evanston, IL LLC Adp of the SNF Aug 1, 2025
Organization, Evanston, IL LLC, Holding company Adp of the SNF Aug 1, 2025
Individual Adp of the SNF Aug 1, 2025
Organization, Evanston, IL Adp of the SNF Aug 1, 2025

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 2

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": "1752019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1376433342",
    "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",
            "fax_number": "314-226-1736"
        },
        {
            "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": "2025-10-02",
        "certification_date": "2025-10-02",
        "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": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Lake 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.