Creve Coeur Manor Health Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CREVE COEUR MANOR HEALTH CARE CENTER LLC

Practice address

1127 Timber Run Dr
Saint Louis, MO 63146-4482

Phone

(314) 434-8361

NPI assigned

Mar 6, 2026

Last updated

Mar 6, 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

Richard J. Destefane

Title

President

Phone

(314) 543-3805

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1772755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772755200000",
    "number": "1578419156",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 TIMBER RUN DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464482",
            "telephone_number": "314-434-8361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREVE COEUR MANOR HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-06",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.