NPIMap

Organization Active NPI

Wellsville Health Care Center, L.L.C.

Doing business as Wellsville Health Care Center

  • Skilled Nursing Facility
  • Wellsville, MO
National Provider Identifier
1902630460
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WELLSVILLE HEALTH CARE CENTER, L.L.C.
Doing business as
Wellsville Health Care Center
Practice address
250 E Locust St
Wellsville, MO 63384-1422
Phone
(573) 684-2002
NPI assigned
Aug 28, 2024
Last updated
Aug 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 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

250 E Locust St
Wellsville, MO 63384-1422

Mailing address

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

Other names 1

  • Wellsville 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
O20241231002607 MO Part A Provider - Skilled Nursing Facility 5496282568 Practice locations: Wellsville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902630460. Details of each certification follow.

Skilled nursing facility certification: CCN 265398

Legal name
WELLSVILLE HEALTH CARE CENTER, L.L.C.
Doing business as
WELLSVILLE HEATH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1989
Last certification
May 8, 2025
Beds
112
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Aug 16, 2024
Organization structure
LLCProprietary
Enrollment address
250 E Locust St
Wellsville, MO 63384-1422
Nursing home name
WELLSVILLE HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wellsville Health Care CenterCCN 265398 · 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
Nov 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11265.7 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Penalties (3 years)
2Fines totaling $20,642

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 31, 2024
Richard J. Destefane Revocable Living Trust Organization, St. Louis, MO 5% Or Greater Indirect Ownership Interest Aug 15, 2024 100%
Trustee of the SNF Aug 15, 2024
Adp of the SNF Jan 20, 2025
Richard J Destefane Individual Corporate OfficerPresident Aug 15, 2024
Reliant Care Group LLC Organization, Saint Louis, MO LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 15, 2024 100%
Adp of the SNF Dec 31, 2024
TLG II LLP Organization, Saint Louis, MO Holding company Adp of the SNF Dec 31, 2024
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC, Management services company, For-profit, Chain home office Operational/Managerial Control Aug 16, 2024
Adp of the SNF Aug 16, 2024
Abdullah Arshad Individual Operational/Managerial Control Jan 2, 2025
Adp of the SNF Jan 2, 2025
Kimberly Harris Individual Operational/Managerial Control Oct 9, 2024
Adp of the SNF Oct 9, 2024
Wellsville Associates LLC Organization, Saint Louis, MO LLC 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 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 33

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

View all 33

Practitioners & affiliated clinicians

Practitioners 2

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": "1724803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1902630460",
    "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": "250 E LOCUST ST",
            "city": "WELLSVILLE",
            "state": "MO",
            "postal_code": "633841422",
            "telephone_number": "573-684-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSVILLE HEALTH CARE CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "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": "Wellsville Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wellsville, MO

Sources for this page

Verify at the official NPI Registry.