Hidden Lake Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HIDDEN LAKE OPCO LLC

Practice address

11728 Hidden Lake Dr
Saint Louis, MO 63138-1765

Phone

(314) 355-8833

Fax

(314) 736-1098

NPI assigned

Jun 22, 2026

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

Other names 1

• Hidden Lake Health Care Center Doing business as

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

{
    "created_epoch": "1782086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782086400000",
    "number": "1669308169",
    "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"
        },
        {
            "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 OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-06-22",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Lake Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Judy Hicks
• Teresa Hicks
• Hidden Lake Al Opco LLC
• Hidden Lake Health Care Center LLC
• Hidden Lake Health Care Center, LLC
• Suhail Hiermandi, DO
• Madeline Lucille Hieser, CF-SLP
• Shay C Hietpas, PA-C
• Stuart Taylor Higano, M.D.
• Michael Higginbotham, MSW

• All providers in Saint Louis, MO
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.