NPIMap

Organization Active NPI

Four Seasons Living Center, LLC

  • Skilled Nursing Facility
  • Sedalia, MO
National Provider Identifier
1538157367
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
FOUR SEASONS LIVING CENTER, LLC
Practice address
2800 Highway TT
Sedalia, MO 65301-1410
Phone
(660) 826-8803
NPI assigned
Oct 6, 2005
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Ashwin Dundoo
Title
Finance
Phone
(314) 543-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

2800 Highway TT
Sedalia, MO 65301-1410

Mailing address

1869 Craig Park CT
Saint Louis, MO 63146-4122
Phone (314) 543-3800

Other identifiers 1

IdentifierTypeStateIssuer
101481109MedicaidMO

Other names 1

  • Four Seasons Living Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091125000151 MO Part A Provider - Skilled Nursing Facility 8426197864 Practice locations: Sedalia, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1538157367. Details of each certification follow.

Skilled nursing facility certification: CCN 265149

Legal name
FOUR SEASONS LIVING CENTER, LLC
Doing business as
FOUR SEASONS LIVING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1980
Last certification
Oct 25, 2024
Beds
239
Ownership / control type
Corporation
Multi-facility organization
Reliant
Organization structure
LLCProprietary
Enrollment address
2800 Highway TT
Sedalia, MO 65301-1410
Nursing home name
FOUR SEASONS LIVING CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Four Seasons Living CenterCCN 265149 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
239228.4 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $25,605

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Four Seasons Living 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 5

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, Creve Coeur, MO 5% Or Greater Indirect Ownership Interest Mar 1, 2018 100%
Richard J Destefane Individual 5% Or Greater Indirect Ownership Interest Jun 30, 1996 100%
Corporate OfficerPresident Jan 1, 2008 100%
Brandy Parker Individual W-2 Managing EmployeeAdministrator Oct 14, 2021 100%
Reliant Care Group LLC Organization, St Louis, MO LLC 5% Or Greater Direct Ownership Interest Jun 30, 1996 100%
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC Operational/Managerial Control Jun 30, 1996

Facilities with the same owner 33

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

View all 33

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": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1538157367",
    "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": "2800 HIGHWAY TT",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653011410",
            "telephone_number": "660-826-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR SEASONS LIVING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "DUNDOO",
        "authorized_official_first_name": "ASHWIN",
        "authorized_official_title_or_position": "FINANCE",
        "authorized_official_telephone_number": "314-543-3800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101481109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Seasons Living Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sedalia, MO

Sources for this page

Verify at the official NPI Registry.