Hidden Lake Health Care Center LLC
Organization Active NPI Skilled Nursing Facility · Saint Louis, MO
NPI 1376433342 · NPPES record last updated Oct 2, 2025
Key facts
- NPI
- 1376433342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- HIDDEN LAKE HEALTH CARE CENTER LLC
- Practice address
- 11728 Hidden Lake Dr
Saint Louis, MO 63138-1765 - Phone
- (314) 355-8833
- NPI assigned
- Jul 9, 2025
- Organization subpart
- No
Authorized official
- Name
- Richard J. Destefane
- Title
- President
- Phone
- (314) 543-3805
Owners & managing parties with NPI records 1
-
Abdullah Arshad, MD
Corporate family (same tax ID) 1
Facilities with the same owner 32
Practitioners 2
-
Naser Almasalmeh, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Hidden Lake Health Care Center
- 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
- Active
- Certified beds
- 67 · 50.2 residents per day on average
- Chain
- Reliant Care Management
- Penalties (3 years)
- 3 · fines totaling $123,610
- Ownership change
- Changed ownership in the last 12 months
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
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
- LLC · Proprietary
- Enrollment address
- 11728 Hidden Lake Dr
Saint Louis, MO 63138-1765 - Nursing home name
- HIDDEN LAKE HEALTH CARE CENTER
- Affiliated entity
- RELIANT CARE MANAGEMENT
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Harold Lutz |
Operational/Managerial Control | Oct 20, 2025 | |
| Adp of the SNF | Oct 20, 2025 | ||
| RCG Inc |
Indirect Ownership Interest | Aug 1, 2025 | 0.01% |
| Richard J. Destefane Revocable Living Trust |
Indirect Ownership Interest | Aug 1, 2025 | 100% |
| Richard J Destefane |
Operational/Managerial Control | Aug 1, 2025 | |
| Indirect Ownership Interest | Aug 1, 2025 | 100% | |
| Reliant Care Group LLC |
Direct Ownership Interest | Aug 1, 2025 | 100% |
| Reliant Care Management Company LLC |
Operational/Managerial Control | Aug 1, 2025 | |
| Adp of the SNF | Aug 6, 2025 | ||
| Abdullah Arshad |
Operational/Managerial Control | Aug 1, 2025 | |
| Adp of the SNF | Aug 1, 2025 | ||
| HL Property, LLC |
Adp of the SNF | Aug 1, 2025 | |
| |
Adp of the SNF | Aug 1, 2025 | |
| |
Adp of the SNF | Aug 1, 2025 | |
| |
Adp of the SNF | Aug 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20251017001983 | MO | Part a Provider - Skilled Nursing Facility | 3870080211 | Practice locations: Saint Louis, MO |
National Provider Directory
- Tax ID family
- Hidden Lake Health Care Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Alzheimer Center (Dementia Center) | 311500000X | |||
| Skilled Nursing Facility | 314000000X | Yes |
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
- Hidden Lake Health Care Center
Other providers in Saint Louis, MO
- Fred G. Hicks
- Jane A Hicks
- Judy Hicks
- Teresa Hicks
- Hidden Lake Al Opco LLC
- Hidden Lake Health Care Center, LLC
- Hidden Lake Opco LLC
- Suhail Hiermandi
- Madeline Lucille Hieser
- Shay C Hietpas
All providers in Saint Louis, 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 Oct 2, 2025. 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.