Nick'S Health Care Center LLC
Organization Active NPI Skilled Nursing Facility · Plattsburg, MO
NPI 1780064071 · NPPES record last updated Jun 2, 2015
Key facts
- NPI
- 1780064071
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- NICK'S HEALTH CARE CENTER LLC
- Practice address
- 253 E Highway 116
Plattsburg, MO 64477-1561 - Phone
- (816) 539-2376
- NPI assigned
- Jun 2, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Robert J Craddick
- Title
- In-House Counsel
- Phone
- (314) 543-3816
Facilities with the same owner 33
Practitioners 4
-
Dennis R Drews, MD
-
Jonathan Lyle Manzer, M.D.
-
Amy O Puderbaugh, DO
Medicare Care Compare: Nursing home
- Listed as
- Nick'S Health Care Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 24, 1999
- Certified beds
- 70 · 66.7 residents per day on average
- Chain
- Reliant Care Management
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2 · fines totaling $21,948
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0948733 | Nicks Health Care Center LLC | Certificate of waiver | Jul 16, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265698
- Legal name
- NICKS HEALTH CARE CENTER, LLC
- Doing business as
- NICKS HEALTH CARE CENTER, LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 24, 1999
- Last certification
- Oct 11, 2024
- Beds
- 70
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Reliant Care Management
- Organization structure
- LLC · Proprietary
- Incorporated
- May 20, 2015 in MO
- Enrollment address
- 253 E Highway 116
Plattsburg, MO 64477-1561 - Nursing home name
- NICK'S HEALTH CARE CENTER
- Affiliated entity
- RELIANT CARE MANAGEMENT
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Richard J Destefane |
Corporate Officer |
May 19, 2015 | 100% |
| James R Wilson |
W-2 Managing Employee |
Sep 18, 2018 | |
| Christian Koenig |
W-2 Managing Employee |
Jul 6, 2015 | |
| Chiquita Kimari |
W-2 Managing Employee |
Mar 14, 2018 | |
| Jonathan Lowell Harrup |
W-2 Managing Employee |
Sep 13, 2016 | |
| Reliant Care Group LLC |
5% Or Greater Direct Ownership Interest | May 19, 2015 | 100% |
| Reliant Care Management Company LLC |
Operational/Managerial Control | Jul 1, 2015 | |
| Rebecca Miller |
W-2 Managing Employee |
Jul 1, 2015 | |
| Dorothy Lewis |
W-2 Managing Employee |
Nov 28, 2017 | |
| Jesse Soondrum |
W-2 Managing Employee |
Jan 10, 2020 | |
| Roderic Sullivan Berry |
W-2 Managing Employee |
Jan 22, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150721002830 | MO | Part a Provider - Skilled Nursing Facility | 2961715867 | Practice locations: Plattsburg, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
253 E Highway 116
Plattsburg, MO 64477-1561
Mailing address
1869 Craig Park CT
Saint Louis, MO 63146-4122
Phone (314) 543-3816
Other providers in Plattsburg, MO
- New Liberty Hospital Coporation
- New Liberty Hospital Corporation
- New Liberty Hospital Corporation
- New Liberty Medical & Hospital Corp
- New Liberty Medical & Hospital Corporation
- Nick'S SNF Opco LLC
- Orta Physical Therapy, Inc.
- Victor Robert Orta
- Louis Loyd Proctor
- School Dist R3 Plattsburg
All providers in Plattsburg, 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 Jun 2, 2015. 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.