NHC Healthcare-Desloge LLC
Organization Active NPI Skilled Nursing Facility · Desloge, MO
NPI 1629013172 · NPPES record last updated Feb 20, 2008
Key facts
- NPI
- 1629013172
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 032609 (MO)
- Legal business name
- NHC HEALTHCARE-DESLOGE LLC
- Practice address
- 801 Brim St
Desloge, MO 63601-3441 - Phone
- (573) 431-0223
- NPI assigned
- Jun 18, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- NATIONAL HEALTHCARE CORPORATION
Authorized official
- Name
- Mel Rector
- Title
- Manager
- Phone
- (636) 946-3677
Owners & managing parties with NPI records 23
-
Edward Burke, M.D.
Member of 2
Facilities with the same owner 100
Practitioners 9
-
Kari Buerck, OT
-
Edward Burke, M.D.
-
Mary Ann Araneta Cusi, OTRL
-
Steven D Ebers, MD
-
Latasha Denise Franklin, MS, OTR/L
-
Hannah Marie Jackson, MA CCC-SLP
-
Emily Beth Kernan, COTA/L
-
Kelsey Elizabeth Ryner, COTA
Affiliated clinicians 2
-
Edward Burke, M.D.
-
Steven D Ebers, MD
Medicare Care Compare: Nursing home
- Listed as
- NHC Healthcare, Desloge
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Feb 15, 1982
- Medicare certification status
- Active
- Certified beds
- 120 · 65.8 residents per day on average
- Chain
- National Healthcare Corporation
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0674287 | NHC Desloge Healthcare | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265158
- Legal name
- NHC HEALTHCARE-DESLOGE LLC
- Doing business as
- PROFESSIONAL HEALTH SERVICES
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 15, 1982
- Last certification
- Apr 24, 2025
- Beds
- 120
- Ownership / control type
- Corporation
- Multi-facility organization
- NATIONAL HEALTHCARE CORPORATION
- Organization structure
- LLC · Proprietary
- Incorporated
- Oct 14, 1999 in MO
- Enrollment address
- 801 Brim Street
Desloge, MO 63601-3441 - Nursing home name
- NHC HEALTHCARE, DESLOGE
- Affiliated entity
- NATIONAL HEALTHCARE CORPORATION
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Robert M Ussery |
Operational/Managerial Control | Jan 1, 2017 | |
| Edward Burke |
Operational/Managerial Control | Nov 13, 2018 | |
| Adp of the SNF | Nov 13, 2018 | ||
| |
Indirect Ownership Interest | Nov 8, 2024 | 4.8% |
| National Health Corporation |
5% Or Greater Indirect Ownership Interest | Feb 1, 2000 | 6.6% |
| Adp of the SNF | Apr 14, 2025 | ||
| Jordan Blair Riddle |
Operational/Managerial Control | Jun 14, 2021 | |
| Adp of the SNF | Apr 14, 2025 | ||
| Melvin Rector |
Corporate Officer |
Feb 1, 2000 | |
| Operational/Managerial Control | Feb 1, 2000 | ||
| Managing Control - Governing Body |
Feb 1, 2000 | ||
| Blackrock Inc |
5% Or Greater Indirect Ownership Interest | Mar 20, 2019 | 12.6% |
| Adp of the SNF | Jan 20, 2010 | ||
| Becca Nixon |
Operational/Managerial Control | May 14, 2024 | |
| Morgan Stanley |
5% Or Greater Indirect Ownership Interest | Nov 8, 2024 | 5.3% |
| |
Adp of the SNF | Feb 1, 2000 | |
| Vanguard Group Inc |
5% Or Greater Indirect Ownership Interest | Mar 27, 2017 | 9% |
| Adp of the SNF | Nov 30, 2006 | ||
| Vicki L Dodson |
Operational/Managerial Control | Jun 1, 2019 | |
| Adp of the SNF | Jun 1, 2019 | ||
| |
Adp of the SNF | Oct 17, 1991 | |
| NHC-Op LP |
5% Or Greater Direct Ownership Interest | Feb 1, 2000 | 99% |
| Operational/Managerial Control | Feb 1, 2000 | ||
| National Healthcare Corporation |
5% Or Greater Indirect Ownership Interest | Feb 1, 2000 | 98% |
| Operational/Managerial Control | Feb 1, 2000 | ||
| Adp of the SNF | Apr 14, 2025 | ||
| NHC/Delaware Inc |
Direct Ownership Interest | Feb 1, 2000 | 1% |
| Dimensional Fund Advisors LP |
5% Or Greater Indirect Ownership Interest | Mar 7, 2023 | 6% |
| Brian Kidd |
Operational/Managerial Control | Jan 1, 2017 | |
| Adp of the SNF | Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111229000719 | MO | Part a Provider - Skilled Nursing Facility | 8022284793 | Practice locations: Desloge, MO |
National Provider Directory
- Part of
- National Healthcare Corporation
Locations
3488 Jeffco Blvd
Ste 102
Arnold, MO 63010
Phone (636) 464-5439
214 W 5th St
Ste De
Joplin, MO 64801
Phone (417) 782-2197
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 032609 | MO | Yes |
Addresses
Primary practice location
801 Brim St
Desloge, MO 63601-3441
Mailing address
801 Brim St
Desloge, MO 63601-3441
Phone (573) 431-0223
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40965 | Other | HEALTHCARE USA | |
| 105309 | Other | MO | BCBS |
Other providers in Desloge, MO
- Leah M Lysaght
- Laura Michelle McClure
- Angela McDowell
- Kathryn Marie McDowell
- Rachel Anne Meredith
- Elizabeth Ann Pack
- Cameron Parker
- Parkland Apothecary LLC
- Parkland Apothecary LLC
- Amber Pashia
All providers in Desloge, 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 Feb 20, 2008. 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.