Hidden Lake Al Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

HIDDEN LAKE AL OPCO LLC

Practice address

11728 Hidden Lake Dr
Saint Louis, MO 63138-1765

Phone

(314) 355-8833

Fax

(314) 736-1098

NPI assigned

Jun 24, 2026

Last updated

Jun 24, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Destefane

Title

President

Phone

(314) 543-3800

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1782259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1467378661",
    "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": "314-543-3800"
        },
        {
            "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",
            "fax_number": "314-736-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN LAKE AL OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-24",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "DESTEFANE",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-543-3800"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Reese Hicks, RD, LD, MS
• Fred G. Hicks, M.D.
• Jane A Hicks, PNP
• Judy Hicks
• Teresa Hicks
• Hidden Lake Health Care Center LLC (Hidden Lake Health Care Center)
• Hidden Lake Health Care Center, LLC (Hidden Lake Health Care Center)
• Hidden Lake Opco LLC (Hidden Lake Health Care Center)
• Suhail Hiermandi, DO
• Madeline Lucille Hieser, CF-SLP

• Assisted Living Facility in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.