NPIMap

Organization Active NPI

Carrie Elligson Gietner Health Care Center, L.L.C.

Doing business as Carrie Elligson Gietner Health Care Center

  • Skilled Nursing Facility
  • Saint Louis, MO
National Provider Identifier
1780404012
Registry record updated Oct 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CARRIE ELLIGSON GIETNER HEALTH CARE CENTER, L.L.C.
Doing business as
Carrie Elligson Gietner Health Care Center
Practice address
5000 S Broadway
Saint Louis, MO 63111-2099
Phone
(314) 752-0000
NPI assigned
Oct 11, 2024
Last updated
Oct 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2024

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) 543-3816

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5000 S Broadway
Saint Louis, MO 63111-2099

Mailing address

1869 Craig Park CT
Saint Louis, MO 63146-4122
Phone (314) 543-3816

Other names 1

  • Carrie Elligson Gietner Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241126000200 MO Part A Provider - Skilled Nursing Facility 3870028004 Practice locations: Saint Louis, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780404012. Details of each certification follow.

Skilled nursing facility certification: CCN 265668

Legal name
CARRIE ELLIGSON GIETNER HEALTH CARE CENTER LLC
Doing business as
CARRIE ELLIGSON GIETNER HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 12, 1997
Last certification
Jun 27, 2024
Beds
130
Ownership / control type
Corporation
Most recent change of ownership
Oct 1, 2024
Organization structure
LLCProprietary
Enrollment address
5000 S Broadway
Saint Louis, MO 63111-2015
Nursing home name
CARRIE ELLIGSON GIETNER HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Carrie Elligson Gietner Health Care CenterCCN 265668 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 12, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
13092.0 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Penalties (3 years)
3Fines totaling $92,561

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
RCG Inc Organization, Saint Louis, MO Corporation, Holding company Adp of the SNF Dec 19, 2024
Richard J. Destefane Revocable Living Trust Organization, Saint Louis, MO Trustee of the SNF Oct 1, 2024
Adp of the SNF Dec 19, 2024
Richard J Destefane Individual 5% Or Greater Indirect Ownership InterestPresident Oct 1, 2024 100%
Corporate OfficerPresident Oct 1, 2024
Adp of the SNF Dec 16, 2024
Reliant Care Group LLC Organization, Saint Louis, MO LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2024 100%
TLG II LLP Organization, Saint Louis, MO Holding company Adp of the SNF Dec 19, 2024
Reliant Care Management Company LLC Organization, Saint Louis, MO Management services company Adp of the SNF Dec 16, 2024
Gietner Associates LLC Organization, Saint Louis, MO LLC Adp of the SNF Dec 16, 2024
Abdullah Arshad Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024
Reliant Care Group of Webster Inc Organization, Saint Louis, MO Corporation, Holding company Adp of the SNF Dec 19, 2024
Rikeesha White Individual Operational/Managerial Control Dec 31, 2024
Adp of the SNF Dec 31, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

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": "1728604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1780404012",
    "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": "314-226-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 S BROADWAY",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631112099",
            "telephone_number": "314-752-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARRIE ELLIGSON GIETNER HEALTH CARE CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-11",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "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": "314-543-3816"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carrie Elligson Gietner Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.