NPIMap

Organization Active NPI

Nick's Health Care Center LLC

  • Skilled Nursing Facility
  • Plattsburg, MO
National Provider Identifier
1780064071
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 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
Last updated
Jun 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Authorized official

Name
Mr. Robert J Craddick
Title
In-House Counsel
Phone
(314) 543-3816

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150721002830 MO Part A Provider - Skilled Nursing Facility 2961715867 Practice locations: Plattsburg, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780064071. Details of each certification follow.

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
LLCProprietary
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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Nick's Health Care CenterCCN 265698 · All quality measures
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
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7066.7 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 $21,948

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0948733Nicks Health Care Center LLC253 E Highway 116, Plattsburg, MO 64477Certificate of waiverJul 16, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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 Individual Corporate OfficerPresident May 19, 2015 100%
James R Wilson Individual W-2 Managing EmployeeAdministrator Sep 18, 2018
Christian Koenig Individual W-2 Managing EmployeeAdministrator Jul 6, 2015
Chiquita Kimari Individual W-2 Managing EmployeeAdministrator Mar 14, 2018
Jonathan Lowell Harrup Individual W-2 Managing EmployeeAdministrator Sep 13, 2016
Reliant Care Group LLC Organization, Saint Louis, MO LLC 5% Or Greater Direct Ownership Interest May 19, 2015 100%
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC Operational/Managerial Control Jul 1, 2015
Rebecca Miller Individual W-2 Managing EmployeeAdministrator Jul 1, 2015
Dorothy Lewis Individual W-2 Managing EmployeeAdministrator Nov 28, 2017
Jesse Soondrum Individual W-2 Managing EmployeeAdministrator Jan 10, 2020
Roderic Sullivan Berry Individual W-2 Managing EmployeeAdministrator Jan 22, 2020

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 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1780064071",
    "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": "314-543-3816",
            "fax_number": "314-543-3880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 E HIGHWAY 116",
            "city": "PLATTSBURG",
            "state": "MO",
            "postal_code": "644771561",
            "telephone_number": "816-539-2376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICK'S HEALTH CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-02",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "CRADDICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "IN-HOUSE COUNSEL",
        "authorized_official_telephone_number": "314-543-3816",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburg, MO

Sources for this page

Verify at the official NPI Registry.