CEDARGATE HEALTH CARE CENTER, L.L.C.
NPI 1124918115
Assisted Living Facility in Poplar Bluff, MO

Q: What is Cedargate Health Care Center, L.L.C.'s NPI number?

The NPI number for Cedargate Health Care Center, L.L.C. is 1124918115. It was assigned to this organization in the NPPES registry on July 9, 2025. The provider is doing business as Cedargate Health Care Center.

Q: What is Cedargate Health Care Center, L.L.C.'s specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since July 09, 2025CLIA 26D0442373 · Waiver

2350 KANELL BLVD, POPLAR BLUFF, MO 63901(573) 785-0188 Get Directions Write a Review

NPPES record last updated: July 9, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Cedargate Health Care Center, L.l.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CEDARGATE HEALTH CARE CENTER, L.L.C. (NPI 1124918115), doing business as Cedargate Health Care Center, is a healthcare organization registered as an assisted living facility in Poplar Bluff, Missouri and active in the NPI registry since July 2025. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Richard J. Destefane, President, as its authorized official.

NPPES Registry Identity

NPI1124918115

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameCEDARGATE HEALTH CARE CENTER, L.L.C.

Location Address2350 KANELL BLVDPoplar Bluff, MO 63901-4036

Mailing Address1869 Craig Park CtSaint Louis, MO 63146-4122 · (314) 543-3816

Phone(573) 785-0188

Organization SubpartNo

Authorized OfficialRichard J. DestefanePresident · (314) 543-3816

Enumeration DateJuly 9, 2025

NPPES CertifiedJuly 9, 2025

✔ NPI 1124918115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

2350 KANELL BLVD, Poplar Bluff, MO 63901

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Other Names 1

Doing Business AsCedargate Health Care Center

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 26D0442373

Cedargate Health Care Center LLC · Poplar Bluff, MO

Active · expires Aug 31, 2026

CLIA Number26D0442373

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateSeptember 1, 2024

Certificate Expiration DateAugust 31, 2026

Laboratory DirectorSherrie Small

Laboratory Phone(573) 785-0188

Laboratory LocationCedargate Health Care Center LLC2350 Kanell Blvd, Poplar Bluff, MO 63901

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CEDARGATE OPCO LLC

Skilled Nursing Facility