HIDDEN LAKE HEALTH CARE CENTER, LLC
NPI 1104716190
Assisted Living Facility in Saint Louis, MO
About Hidden Lake Health Care Center, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
HIDDEN LAKE HEALTH CARE CENTER, LLC (NPI 1104716190), doing business as Hidden Lake Health Care Center, is a healthcare organization registered as an assisted living facility in Saint Louis, Missouri and active in the NPI registry since July 2025. The organization holds a CLIA Waiver certificate valid through December 5, 2027 and lists Richard J. Destefane, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 26D0994184
Hidden Lake Health Care Center, LLC · Saint Louis, MOOther Providers at the Same Location NPPES 7
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SAINT LOUIS, MO 63138
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Hidden Lake Health Care Center, LLC's NPI number?
The NPI number for Hidden Lake Health Care Center, LLC is 1104716190. It was assigned to this organization in the NPPES registry on July 9, 2025. The provider is doing business as Hidden Lake Health Care Center.
Where is Hidden Lake Health Care Center, LLC located?
Hidden Lake Health Care Center, LLC is located at 11728 Hidden Lake Dr, Saint Louis, MO 63138. The listed phone number is (314) 355-8833.
What is Hidden Lake Health Care Center, LLC's specialty?
The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.
Does Hidden Lake Health Care Center, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 26D0994184) is associated with this NPI, valid through December 5, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Hidden Lake Health Care Center, LLC was last updated on September 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
