NPIMap

Organization Active NPI

Portageville Health Care Center, L.L.C.

Doing business as Portageville Health Care Center

  • Skilled Nursing Facility
  • Portageville, MO
National Provider Identifier
1912453986
Registry record updated Aug 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
LC001502456 Issued in MO
Legal business name
PORTAGEVILLE HEALTH CARE CENTER, L.L.C.
Doing business as
Portageville Health Care Center
Practice address
290 W State Highway 162
Portageville, MO 63873-9397
Phone
(573) 379-2017
Fax
(573) 379-2735
NPI assigned
Aug 30, 2016
Last updated
Aug 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2016

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) 543-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X LC001502456 MO Primary

Addresses

Primary practice location

290 W State Highway 162
Portageville, MO 63873-9397

Mailing address

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

Other names 1

  • PORTAGEVILLE 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
O20170104001178 MO Part A Provider - Skilled Nursing Facility 0648551754 Practice locations: Portageville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912453986. Details of each certification follow.

Skilled nursing facility certification: CCN 265549

Legal name
PORTAGEVILLE HEALTH CARE CENTER LLC
Doing business as
PORTAGEVILLE HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1993
Last certification
May 1, 2025
Beds
60
Ownership / control type
Corporation
Multi-facility organization
RELIANT CARE MGMT
Most recent change of ownership
Dec 1, 2016
Organization structure
LLCProprietary
Enrollment address
290 W State Highway 162
Portageville, MO 63873-9397
Nursing home name
PORTAGEVILLE HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Portageville Health Care CenterCCN 265549 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6057.9 residents per day on average
Chain
Reliant Care Management34 facilities in the chain
Penalties (3 years)
2Fines totaling $240,603

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Portageville Health Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the 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, Owned by another organization or individual Indirect Ownership Interest Dec 1, 2016 0.01%
Richard J. Destefane Revocable Living Trust Organization, Saint Louis, MO Adp of the SNF Mar 1, 2018
Indirect Ownership Interest Mar 1, 2018 100%
Richard J Destefane Individual Operational/Managerial Control Dec 1, 2016
Adp of the SNF Mar 1, 2018
Indirect Ownership Interest Mar 1, 2018 100%
Jean Rice Individual Operational/Managerial Control May 8, 2017
Adp of the SNF May 8, 2017
Reliant Care Group LLC Organization, Saint Louis, MO LLC, Holding company, Owned by another organization or individual Direct Ownership Interest Dec 1, 2016 100%
TLG II LLP Organization, Saint Louis, MO Holding company Adp of the SNF Dec 1, 2016
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC, Management services company, Chain home office Operational/Managerial Control Dec 1, 2016
Adp of the SNF Sep 19, 2025
Abdullah Arshad Individual Operational/Managerial Control Sep 15, 2024
Adp of the SNF Sep 15, 2024
RC Tier Associates, L.L.C. Organization, Saint Louis, MO LLC, Holding company Adp of the SNF Dec 1, 2016
Portageville Associates, L.L.C. Organization, Saint Louis, MO LLC Adp of the SNF Dec 1, 2016

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 32

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

View all 32

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1912453986",
    "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": "290 W STATE HIGHWAY 162",
            "city": "PORTAGEVILLE",
            "state": "MO",
            "postal_code": "638739397",
            "telephone_number": "573-379-2017",
            "fax_number": "573-379-2735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGEVILLE HEALTH CARE CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-30",
        "last_updated": "2016-08-30",
        "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": "314-543-3800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "LC001502456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORTAGEVILLE HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portageville, MO

Sources for this page

Verify at the official NPI Registry.