Healthcare Provider Details

I. General information

NPI: 1063351260
Provider Name (Legal Business Name): BERNARD SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 W PINE BLVD
SAINT LOUIS MO
63108-2205
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-0200
  • Fax: 314-371-3297
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS E DESTEFANE
Title or Position: PRESIDENT
Credential:
Phone: 314-543-3800