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General NPI Number Information
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NPI Number | 1730050964
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Entity Type | Organization
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Legal Business Name | HILLSIDE HEALTH CARE CENTER, LLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1265 MCLARAN AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63147-1606
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Country | US
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Telephone | 314-388-4121
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Fax |
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Provider Business Mailing Address
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Address Line | 1869 CRAIG PARK CT
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4122
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Country | US
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Telephone | 314-543-3805
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Fax | 314-226-1736
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD J. DESTEFANE
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Credential |
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Telephone | 314-543-3805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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