NPIMap

Organization Active NPI

Odessa Health Care Center, L.L.C.

Doing business as Odessa Health Care Center

  • Skilled Nursing Facility
  • Odessa, MO
National Provider Identifier
1942019559
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ODESSA HEALTH CARE CENTER, L.L.C.
Doing business as
Odessa Health Care Center
Practice address
609 Golf St
Odessa, MO 64076-1462
Phone
(816) 230-7530
Fax
(816) 633-7661
NPI assigned
Jan 7, 2025
Last updated
Jan 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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) 422-7910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

609 Golf St
Odessa, MO 64076-1462

Mailing address

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

Other names 1

  • Odessa 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
O20251017003687 MO Part A Provider - Skilled Nursing Facility 9638666027 Practice locations: Odessa, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942019559. Details of each certification follow.

Skilled nursing facility certification: CCN 265501

Legal name
ODESSA HEALTH CARE CENTER, L.L.C.
Doing business as
ODESSA HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1992
Last certification
May 28, 2024
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
RELIANT CARE MANAGEMENT
Organization structure
LLCProprietary
Enrollment address
609 Golf St
Odessa, MO 64076-1462
Nursing home name
ODESSA HEALTH CARE CENTER
Affiliated entity
RELIANT CARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Odessa Health Care CenterCCN 265501 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6057.4 residents per day on average
Chain
Reliant Care Management34 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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 Jan 25, 2025 0.01%
Richard J. Destefane Revocable Living Trust Organization, Saint Louis, MO 5% Or Greater Indirect Ownership Interest Jan 25, 2025 100%
Adp of the SNF Jan 25, 2025
Richard J Destefane Individual 5% Or Greater Indirect Ownership InterestPresident Jan 25, 2025 100%
Corporate OfficerPresident Jan 25, 2025 100%
Adp of the SNF Jan 25, 2025
Reliant Care Group LLC Organization, Saint Louis, MO LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 25, 2025 100%
TLG II LLP Organization, Saint Louis, MO Holding company Adp of the SNF Jan 25, 2025
Reliant Care Management Company LLC Organization, Saint Louis, MO LLC, Management services company, Chain home office Operational/Managerial Control Jan 25, 2025
Adp of the SNF Feb 3, 2025
Abdullah Arshad Individual Operational/Managerial Control Jan 25, 2025
Adp of the SNF Jan 25, 2025
Odessa Re Associates, L.L.C. Organization, Saint Louis, MO LLC Adp of the SNF Jan 25, 2025
Wesley Page Individual Operational/Managerial Control Jan 25, 2025
Adp of the SNF Jan 25, 2025

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 1

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": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1942019559",
    "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": "609 GOLF ST",
            "city": "ODESSA",
            "state": "MO",
            "postal_code": "640761462",
            "telephone_number": "816-230-7530",
            "fax_number": "816-633-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODESSA HEALTH CARE CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "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": "314-422-7910"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odessa Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odessa, MO

Sources for this page

Verify at the official NPI Registry.