NPIMap

Organization Active NPI

Eldercare of Mid-Missouri IV, Inc.

Doing business as StoneBridge De Soto

  • Skilled Nursing Facility
  • De Soto, MO
National Provider Identifier
1487811436
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ELDERCARE OF MID-MISSOURI IV, INC.
Doing business as
StoneBridge De Soto
Practice address
1550 Villa Dr
De Soto, MO 63020-2586
Phone
(636) 586-6559
NPI assigned
May 19, 2008
Last updated
Dec 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Authorized official

Name
Mr. Mark Lierman
Title
Secretary - Treasurer
Phone
(636) 477-3280

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X 035678 MO
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1550 Villa Dr
De Soto, MO 63020-2586

Mailing address

1550 Villa Dr
De Soto, MO 63020-2586
Phone (636) 477-3280

Other identifiers 1

IdentifierTypeStateIssuer
107812307MedicaidMO

Other names 1

  • StoneBridge De Soto Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080812000634 MO Part A Provider - Skilled Nursing Facility 3375618218 Practice locations: De Soto, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487811436. Details of each certification follow.

Skilled nursing facility certification: CCN 265772

Legal name
ELDERCARE OF MID-MISSOURI IV, INC.
Doing business as
STONEBRIDGE DESOTO
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 20, 2003
Last certification
Mar 13, 2025
Beds
56
Ownership / control type
Limited Liability Corporation
Multi-facility organization
STONEBRIDGE SENIOR LIVING
Most recent change of ownership
May 1, 2008
Organization structure
CorporationProprietary
Enrollment address
1550 Villa Dr
De Soto, MO 63020-2586
Nursing home name
STONEBRIDGE DESOTO
Affiliated entity
STONEBRIDGE SENIOR LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Stonebridge DesotoCCN 265772 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 20, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5651.3 residents per day on average
Chain
Stonebridge Senior Living12 facilities in the chain
Penalties (3 years)
1Fines totaling $6,368

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Beth Miller Individual Corporate OfficerSecretary Jan 17, 2023
Eric Doerhoff Individual Operational/Managerial Control Nov 1, 2021
Adp of the SNF Nov 1, 2021
Individual Adp of the SNF Jun 1, 2023
Eldercare Management Services Inc Organization, Saint Charles, MO Corporation, Management services company, Chain home office Operational/Managerial Control Mar 12, 2008
Adp of the SNF Jul 16, 2025
Jeanne Thayer Individual Operational/Managerial Control Nov 1, 2021
Adp of the SNF Nov 1, 2021
Wipfli LLP Organization, Clayton, MO Adp of the SNF Jan 1, 2025
Kellie Cook Individual Adp of the SNF Jul 7, 2011
Bridge Rehabilitation Inc Organization, Saint Charles, MO Corporation, Medical provider/supplier Operational/Managerial Control Feb 1, 2024
Adp of the SNF Apr 22, 2025
Mark W Lierman Individual 5% Or Greater Direct Ownership InterestPresident Nov 1, 2021 100%
Corporate OfficerPresident Nov 1, 2021 100%
Operational/Managerial Control Nov 1, 2021
Adp of the SNF Nov 1, 2021
Forvis Mazars LLP Organization, Springfield, MO Consulting firm Adp of the SNF Jan 25, 2016
Busey Corporation Organization, Clayton, MO Financial institution Operational/Managerial Control Sep 10, 2023
Laurence Lum Individual Operational/Managerial Control Jan 1, 2020
Adp of the SNF Jan 1, 2020
Jennie Lessor Individual Operational/Managerial Control Mar 16, 2023
Adp of the SNF Mar 16, 2023
Lierman Family Co IV, LLC Organization, Saint Charles, MO LLC Adp of the SNF Mar 12, 2008

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 11

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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 2

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": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1487811436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 VILLA DR",
            "city": "DE SOTO",
            "state": "MO",
            "postal_code": "630202586",
            "telephone_number": "636-477-3280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 VILLA DR",
            "city": "DE SOTO",
            "state": "MO",
            "postal_code": "630202586",
            "telephone_number": "636-586-6559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERCARE OF MID-MISSOURI IV, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "LIERMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SECRETARY - TREASURER",
        "authorized_official_telephone_number": "636-477-3280",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "MO",
            "license": "035678",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107812307",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "StoneBridge De Soto",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Soto, MO

Sources for this page

Verify at the official NPI Registry.